Staffordshire, West Midlands
and National ASC Ratings
Ratings published up to 25th July 2016
ASC Ratings by Service Type: England
active locations
2
ASC Ratings by Service Type: West Midlands
active locations
3
ASC Ratings by Service Type: Staffordshire
active locations
4
Ratings by size of care home: England
active locations
5
Ratings by size of care home: West
Midlands active locations
6
Ratings by size of care home:
Staffordshire active locations
7
All ASC ratings by key question and overall:
England active and inactive locations
Please note that these ratings include those for all adult social care
locations, including hospices. They incorporate locations that are
now no longer registered.
8
All ASC ratings by key question and overall:
West Midlands active and inactive locations
Please note that these ratings include those for all adult social care
locations, including hospices. They incorporate locations that are
now no longer registered.
9
All ASC ratings by key question and overall:
Staffordshire active and inactive locations
Please note that these ratings include those for all adult social care
locations, including hospices. They incorporate locations that are
now no longer registered.
10
Leadership in
ASC –
our findings
Rachel Davis
1
CQC purpose and role
Our purpose
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
12
The Mum (or anyone you love) Test
Is it responsive to
people’s needs?
Is it
effective?
Is it
safe?
Is it
well-led?
Is it
caring?
Is it good enough for my Mum?
13
Current ratings overall and by key question
7220 services rated at
September 2015
Source: Ratings data extracted 11/09/2015
14
Ratings by service type
Source: Ratings data extracted 11/09/2015
15
Themes from Well-led:
Outstanding
CQC Published reports – sampled for data on well-led in mid June. Sample size 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted).
16
Themes from Well-led:
Outstanding sample only
Themes common to outstanding services in the sample
include:
• People who use services, relatives and staff speak highly
of the service.
• Effective monitoring, quality assurance and audit
systems.
• Open culture - people who use services/staff/relatives
given the opportunity to share views and any issues are
addressed.
• 75 per cent of services had a registered manager in post
consistently, and that manager is supportive of their staff.
• Good leadership extends beyond the manager and
includes the provider.
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 17
services with inadequate ratings for well-led.
Themes from Well-led:
Outstanding sample only
• Effective systems in place for managing and developing staff.
• Safe care actively promoted – effective
“This place is brilliant,
oversight of care and staff communication
• A can do, will do, attitude.
• Effective partnership working.
• Culture of continuous development of the
service/manager/staff with best practice
being followed.
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.” and “I love it here, I was
given this opportunity to make a
difference in people’s lives and
I’m so thankful for the manager
for that.”
• Service and/or staff being recognised through national or
local awards.
• Strong links with the local community in just under half of the
services.
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 18
services with inadequate ratings for well-led.
What makes a service Outstanding?
Examples of well-led services
One member of staff told us ”The service
has eight values which are focused on the
person”. Staff were also keen to tell us
“good things about the service are the
activities and the support. It’s great to see
the reaction of people after they have been
somewhere new. People want to move out
because they are ready. The service has
built their independence and confidence
around other people”.
There was a culture of openness
in the home, to enable staff to
question practice and suggest
new ideas. The service used
‘thinking meetings’ to enable all
to raise or to explore dilemmas.
Everyone was then invited to
help find solutions.
We saw there was little staff turnover
and it was a settled staff team.
Staff had been working with the same
person for a number of years. The service
worked hard to match people with staff
and we saw one member of staff had
been caring for the same person for over
three years. Where there were to be staff
changes we saw people were consulted
in writing and were involved in the
process.
We found that vision and values
were imaginative and personcentred and made sure that
people who lived there were at
the heart of the service.
The manager’s philosophy of care for the
service : “We keep people active and engaged
and find new things for them to do so they
can have a better quality of life” and, “We
have a programme of life enhancement and
inclusion that we have worked on for 27 years
and have never stopped. That’s why people
want to look at our model of care”.
The manager’s knowledge of
underpinning research and best
practice in dementia care included an
understanding of how environmental
design impacts on people. This
included the lighting, décor, colour
scheme, and flooring being reviewed
not only for safety but in terms of the
effects this has on individual’s
behaviour.
The home worked with various colleges and
schools and give work experience to student’s
placements and work experience including the
Prince’s Trust. The registered manager also
went to local schools to talk to them about the
home and about older people in general and
discussed ways the young and old can help
each other. Follow up visits were arranged
and young people were encouraged to visit
and take part in activities and planned events.
This encouraged and supported community
cohesion.
The service was actively working with other organisations
to contribute to research about the design and delivery of
more effective and relevant home care services. This
work had resulted in the setting up of a six months pilot
project. The project provided emergency care for people
if their family carer became unwell and unable to cope
and the person may otherwise have been admitted to
hospital. The aim of the project was to identify a possible
unmet need for this service and decide at the end of the
pilot if funding this type of service would achieve better
outcomes for people living in the community.
The managers’ ethos was reflected throughout the
service with staff being observed reassuring people
using the contented dementia learning and having
conversations with people without asking
questions which helped people be calm.
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 19
services with inadequate ratings for well-led.
Themes from Well-led:
Inadequate sample only
CQC Published reports – sampled for data on well-led. In mid June. Sample size 127 services with inadequate ratings for well-led.
20
Themes from Well-led:
Inadequate sample only
Themes common to inadequate services in the sample
include:
• People who use services and their relatives speak of
continuous management churn and change.
• Poor care planning resulting in lack of personalised care.
• Closed culture - people who use services/staff/relatives
feeling unable to raise issues or their views not listened
to or acted upon.
• No registered manager or, if in post, unable to lead and
support staff effectively and consistently.
• Poor oversight of care with care plans not up to date,
reviewed or followed.
CQC Published.
21
Themes from Well-led:
Inadequate sample only
• Ineffective systems to identify and manage risks and
•
•
•
•
•
learn from mistakes.
Lack of supervision and training opportunities to develop
staff skills.
Poor working relationship between the manager and the
provider.
Under developed partnership working and community
links.
Unawareness of best practice.
Notifications to CQC not being made.
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 22
services with inadequate ratings for well-led.
What makes a service Inadequate
on leadership? Examples
The manager was being supported by a regional
manager and a registered manager from another
home. However, it was clear when speaking with the
regional manager and the manager that they did not
have a working relationship that had identified the
challenges and risks faced by the home. There was no
structured process which identified how they would
work together to improve the service that people
received. We saw the manager did not have access to
all of the computerised systems which restricted them
being able to carry out their role.
The registered manager and staff did not know what the
aims and objectives of the service were when we asked
them. The provider did not have a clear set of values and
behaviours they required from their staff. The registered
manager and the provider were not aware of the
shortfalls in the quality of the service found at the
inspection.
Some of the people we spoke with raised concerns
with us about the quality of the management at
the home. One person said; “I don’t know the
manager.” Another said, I know who the manager
is, I can recognise them by their pinny [pinafore].
However I don’t know their name.” A relative said,
“The managers change here, no one has stayed. I
don’t know if they’ve got a manager now.”
Records for the house meetings did not
show the names or numbers of staff that
attended the meetings. They
demonstrated that a wide range of topics
had been discussed and that staff had
been kept up to date on a range of
matters. Whilst a staff member told us
they could have their say at meetings,
minutes read like a list of instructions
and there was limited evidence that staff
views had been sought.
People’s care was planned
and reviewed by the
registered manager without
the involvement of staff,
who provided people’s care,
and without involvement of
people themselves. Reviews
of care records had not
identified the shortfalls in
assessments, care planning
and care delivery that we
found.
We saw examples of recurring incidents
involving the same people and staff, but there
had been no changes to the way that care was
delivered to this person and no evidence of
learning from these incidents. The incident
report forms were all kept within people's care
files with no central accident and incident log
for any incidents to be reported in. This meant
that there was no easy way for staff to monitor
any patterns in accidents and incidents and
they were not able to learn from any incidents
that had occurred.
During our inspection we were also unable to evidence
the role they (the registered manager) played in
managing the registered service.
Minutes of a recent board highlighted their focus on
securing partnerships, referrals, completing proposals for
funding, developing networks and involvement in
projects to improve people’s employability, as well as
overseeing a young people’s service. The minutes also
reflected the registered manager’s directly saying they
were struggling to find time to commit to all their
responsibilities.
The registered manager did not have the skills and
knowledge to lead the staff effectively. Staff had not
received information and guidance about how to provide
safe care to meet people’s individual needs. A deputy
manager worked at the service, they were not clear about
their management role and responsibilities, and told us, “I
am more of a glorified carer”.
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 23
services with inadequate ratings for well-led.
Our focus…
People
are at
the
heart
of all
we do
24
An outstanding care home
"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
25
Thank you
www.cqc.org.uk
[email protected]
@CareQualityComm
Segun Oladokun
Head of Inspection ASC London
26