The Care Quality Commission uses five key questions as the basis of its inspection of care homes in England.
We know from our experience working with owners and their managers that the most complex and, often most difficult question they have to answer is: Is my service well-led?
The main reason for this is that the subject covers a multitude of issues and challenges relating to both staff and residents. Ultimately, we are talking about the very culture of the organisation.
The CQC defines “well-led” as: “The leadership, management and governance of the organisation make sure it’s providing high quality care that’s based around your individual needs, that it encourages learning and innovation and that it promotes an open and fair culture.”
Make a difference
So what can care homes do to make the difference between an Inadequate and an Outstanding rating? What is the difference between Good and Outstanding?
The CQC considers a number of criteria in assessing whether an organisation promotes a positive culture that treats residents and staff as individuals.
Does the operator have a whistle-blowing policy which is accessible to all staff? The lack of such a policy is clearly inadequate, but having one that is kept in the manager’s office and never shared means that improvement is required.
Having a policy is one thing; far more important is whether an operator has properly embedded it into the culture of the organisation. Is the operator receptive to complaints and, when they are made, are they acted upon promptly and effectively?
Hold staff meetings
Another area where many homes fall down concerns staff meetings. Inadequate means meetings simply do not take place, with the manager preferring an approach of “they know where I am if they need me”.
To be achieving Good or Outstanding, there needs to be a culture of regular staff engagement with records of meetings and evidence that actions were followed up in a timely and effective manner.
The same rule applies to residents. Regular meetings are an essential part of providing a person-centred service in which each resident is treated as a person in their own right.
The really outstanding homes are constantly trying to find new and innovative ways to gather people’s views, enabling them to be empowered and happy to voice their opinions.
Strong management structures
The CQC also wants to understand what management structure and practices an operator has in place.
Hard though it is to believe, some homes still operate without a registered manager and, in the worst cases, without any manager at all.
The role of the care home manager has changed beyond all recognition in recent times. Today’s manager is as much an auditor with responsibility for ensuring that robust business processes are in place and being adhered to.
The manager is expected to oversee regular audits in medication, kitchen facilities, infection control, laundry, cleaning and a host of other areas.
One of the areas any CQC inspection will probe is whether a manager has got the budget they require to be able to carry out their role effectively.
Effective policies and procedures
Well-led also means having a full set of policies and procedures in place which are up to date and readily available to be viewed.
Any inspection will be scrutinised to ensure they are properly fit for purpose and relevant to the home in question. It is not unusual to see policies with the wrong name of the home on the front of them.
Quality assurance is another critically important determinant as to whether a home is well-led. It is important to have questionnaires for professionals, residents, their families and staff.
Inadequate means no evidence of questionnaires or other quality assurance tools being utilised. We have personally heard managers tell us there is no point to questionnaires because “nobody ever completes or returns them.”
How well an operator engages with local agencies and other relevant organisations is not just an important aspect of any CQC inspection – it is fundamental in ensuring that residents and staff in a home are able to maximise the opportunities that should be made available to them.
One of the most important partnerships surrounds safeguarding and the need to ensure a proactive approach which fully engages with the appropriate local professionals.
There needs to be clear procedures for any safeguarding matters that arise including a prompt response and ensuring that they are always dealt with in an open, transparent and objective way.
Keep up-to-date with latest guidance
Keeping up to date with new research and innovation, guidance and care sector developments is vital in ensuring an operator is able to provide the best possible care to its residents and employee engagement with its staff.
Fundamental to the success of any business, let alone a care home, is good communication.
Those operators who do it well are communicating in many different ways with the process of communication being part of the organisation’s very fabric.
On a staff level, good practice is ensuring that employees are given annual appraisals and that they are properly recorded and kept on file.
Similarly, the CQC will look for evidence that regular supervisions of staff are taking place. It is unacceptable for managers to say they don’t have time to implement supervisions because “staff are always too busy” or for staff to say they don’t like supervisions because they “provide a platform for the manager to tell them off”.
Best practice in communication also means evidence of notices around the home communicating with staff, residents and families.
The communication with families is often overlooked, but many good and outstanding homes actively involve family members and friends, whether that is inviting them in for lunch or giving them the chance to spend private time with loved ones.
Have well defined roles
Another important consideration in determining whether a care home is well-led is how clearly defined responsibility and accountability is within the operation.
Inspectors will always endeavour to find out how aware staff are of their roles and responsibilities, how well have these been communicated to staff by management and whether they are regularly considered at team meetings or supervisions. They will also look at the opportunities a member of staff has to discuss and review them with management.
Accountability also means how accountable staff are to residents. Consider if staff are accessible and willing to listen to requests and requirements or whether they come across as too busy or distant in their relationships with residents.
The depth of questioning conducted by the CQC in carrying out its inspections will allow the regulator to decide whether an organisation’s approach is inadequate, requires improvement, good or, in those exceptional cases, outstanding.
Homes that are achieving outstanding status are genuinely going above and beyond every day.
By Ben Challinor, Co-Founder and Consultancy Director of Caresolve.