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Outstanding in ‘Safe’

by Bryson Gifford BEM, Operations Director and Continuous Improvement. Kingswood Court Nursing Home

Out of all the areas inspected by the Care Quality Commission (CQC) SAFE has been identified as the hardest area to obtain Outstanding in, it makes up only 0.5 percent of all the Outstanding’s awarded and clearly providers are wondering if it is even achievable or some kind of “holy grail”.

 It is with this theme in mind that I was approached by the Outstanding Society to be a guest speaker during their last online forum, which attracted in the region of circa. 130 participants from across the Care Sector, with the aim of sharing ideas from “Outstanding” providers.

It is at this point that I must say I do not consider myself an expert with all the textbook answers. I am the Group Director of Operations and Continuous Improvement for a small family owned and run nursing home group, but we have had some success on our inspections over the past 6 years having achieved four back-to-back overall Outstanding inspections across our different homes, including one home being Outstanding in all areas, including SAFE. The aim of this article is to share our approach to nursing care and hopefully promote some thought on how you deliver your respective service and how this is communicated during a CQC inspection.

It may sound strange but firstly forget about the Outstanding and initially focus more closely on developing a service that works most effectively for you. Once you have developed a service that you believe is Outstanding, have the confidence and evidence across the board to convey this to anyone, including CQC inspectors.

We believe there are two areas that will significantly impact on the day-to-day running of your service and also on your inspection. The first one is people and the second is procedures.


People could mean staff, residents, visitors, or multi-disciplinary teams. This group will always say what they feel and there is rightly no way of controlling this. If they do not know what is going on and have not bought into your ethos and procedures this will be reflected in your daily running and CQC report. By nature, many of the staff across the care sector are extremely kind-hearted, do the most incredible work on the frontline – as C-19 has proven – but for no apparent reason hate the pressure of a CQC inspection and can fall to pieces with unjustified fear and nerves on the day of an inspection. This can prevent them from truly demonstrating all the Outstanding work that you may be doing on a day-to-day basis, and they will miss their chance to “shine”. We have found the following steps useful for helping prepare them for this.

Accountability equals confidence – we have created “Champions” for specific areas and given staff the necessary training to lead in these areas. Within our procedures we have a robust system of audits which staff are accountable for. We also do a series of unannounced “mock inspections” internally and externally which have been useful in giving our staff the confidence to talk to anyone, inspectors included, about what they do daily. Getting staff to accept change, which happens routinely if you are continuously trying to improve, as a positive, is the most difficult part but if it is driven by them, it becomes second nature. It is extremely rewarding to see just how proud all the staff are when the home achieves an Outstanding rating, especially when they have driven the change.


We believe that lots of small changes over time leads to excellence, which is reflected in our procedures. It is unrealistic to try and make immediate wholesale changes in the care sector when you are under pressure to deliver your existing services. It is far easier to continuously improve and evidence this in small increments over time.

Although everyone’s procedures will differ in line with the particular service they are delivering, we have found the following useful when developing our own.

External input. All previous CQC inspections are online for all to see, make use of them to learn lessons and most importantly improve your service. We generally review these by starting with ones where providers may have missed a certain area and improvement is required. We try to ensure that we cover these areas by developing our procedures and checks to automatically incorporate them so that they are not overlooked. Equally, we also try and incorporate any Outstanding practises into our daily procedures if we feel they will benefit our residents. We have phoned other Outstanding providers and even visited them in person to share lessons with them. It’s amazing what an email or phone call can achieve.

Internal Input. Family members, residents and staff have regular ways of providing input which is part of our routine procedures. An example: The standard shower house is 150cm long, a young carer asked for longer hoses, 2m + as this would improve ability to shower residents on a shower chair in hard-to-reach areas. This may seem trivial for some but is exactly the type of small change that leads to outstanding. Why is this SAFE outstanding?

1 – It protects the backs of our carers whilst they are carrying out routine tasks and makes it simpler to perform a routine task.

2 – It allows us to improve the showering effectiveness for residents in hard-to-reach areas prone to potential excoriation etc. prevent any potential degradation in these areas.

The easiest thing would be for staff to say nothing, go through the motions and continue with the standard issue hose, but this type of input demonstrates the staffs’ approach to safety by considering it in the first place and highlights that there are procedures in place for them to do so. It is quick, cheap and easy to fix and simply a better idea. Multiply this small example by twenty plus similar ones and you start to see significant improvement, leading to Outstanding.

We are only human, and complaints occur for all in the care sector and is not something an “Outstanding” home is immune to. We have tried to use our complaints process as a positive opportunity for improvement, no matter how small the complaint is and will always try and make changes and improvements on the back of these to our current procedures to mitigate any future risk. Given the amount of time dedicated to investigations, it is also an extremely easy way of documenting what actions you have taken and how these have improved safety or any other relevant area. It is how you deal with a complaint that is the most important aspect.

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