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The Journey to Achieving an Outstanding CQC Rating

Article by Russell Leese, Director, The Outstanding Society
Published in Care England’s May Care Agenda.

For many providers and registered managers, a CQC outstanding rating is the goal that is aspired to within our sector. For most who have achieved it, the feedback that we have received highlights the immense pride that the team of staff feel when receiving this accolade.

For others striving to achieve an outstanding rating, can become a source of frustration and disappointment, particularly when a service feels that they are offering outstanding support to the people they care for.

The journey to achieving an outstanding rating is always going to be unique and very much dependent upon the individuals being supported within the care home in which they live. However, there are some fundamental principles, which are not ‘rocket science’ which can be applied in all settings to improve the
chances of achieving an outstanding rating. What is required, is a clear vision and hard work!

I will therefore use my own journey as an example of how ‘outstanding practice’ can be converted into an outstanding CQC rating. I took over the management of a group of residential services well over a decade ago
which provide specialist support to people with autism spectrum conditions, learning disabilities and complex behaviour. At the time, the care and support were good in each of the services, though there was very little in
the way of consistency in support planning, monitoring and evidencing the outcomes of the good quality support that people were receiving. The care and support were person-centred, but again this was not evidenced well or consistently implemented. At the time, it was clear that consistency was required in establishing high quality support plans that monitored the positive outcomes that people were experiencing, and that there was a need to enhance the person-centred culture. Hence a review of all of the approaches used and the supporting documenting systems and procedures relating to care and support began.
During this period of development / transition, which took several years of trial and error and successful implementation, the inspection standards were amended, and the current rating system introduced. This helped massively, in that it offered a clear framework to work within and to demonstrate what is perceived to
be good quality care and support. Because the systems that were introduced were developed according to the individuals being supported, many of the systems used to monitor and collate information, while involving people in their support planning, were unique and therefore identified as innovative in future inspections.
A review of the auditing systems was conducted, and a new system was developed according to the changes which we had developed over the previous years. Equally, if not more importantly, this measured our performance against the current inspection standards. Robust and consistent implementation of this audit tool identified areas of strength as well as those areas that we felt still required further development.
Meanwhile, our workforce development plan evolved in line with the changes in systems to ensure that all staff were aware of the support they should offer each individual and how to effectively monitor progress and outcomes for individuals supported.

Amongst all of this, it was essential to maintain a positive culture as there had been and were continuing to be many changes to the way that people worked. Person centred values were instilled consistently across the teams so that everyone shared similar values and goals. There was a common belief that we were offering ‘the very best’ support that the people who lived in the services could receive. Whilst morale had dipped due to the additional pressures of making progress, the management team worked incredibly hard to maintain and increase the positivity across the services by responding to the staff and teams using the same person-centred values for staff and service users alike. To have developed and then to continue to have a strong and diverse group of managers, who were able to support each other was critical in leading the services forward and continually improving the care and support being delivered.

In 2014, the first home was inspected using the current standards and the inspector felt that the home should be rated as Outstanding. One more service received the Outstanding rating the same year and two more received the same outcome the following year. A fifth service received Outstanding the year after this.

Since this time, my colleagues and I have shared as much as possible with other providers, through the Outstanding Society, speaking at conferences, inviting other providers to visit and ‘see what Outstanding looks like’.

For me, the key areas to focus upon are:

  • Be aware of the standards and in particular identify if each of the 5 KLOEs is answered positively – a service needs to be at least Good in all of these areas to be Outstanding!
  • Importance of culture
  • Importance of Person-Centred approaches
  • Importance of skilled and motivated staff
  • Importance of leadership
  • Importance of environments
  • Importance of innovative practice
  • Importance of external links
  • Importance of going the extra mile
  • Look at ‘Outstanding’ service reports to confirm what Outstanding looks like for them
  • Think about examples of what your service does that might be considered ‘Outstanding’
  • Evidence what is Outstanding – produce an evidence file of what you consider to be ‘your outstanding practice’ so that this can be presented to the inspector on the day of inspection.

I have since moved to another organisation and following a very similar strategy to that implemented in my previous company. The starting point was very similar, which has made the journey almost familiar, but is still unique.
I think it is worth emphasising how important person-centred support is and how recognising and evidencing the achievements of individuals is so important, no matter how big or how small those achievements are.

The photographs (below) demonstrate how diverse individual achievements can be in relation to what is important to the person or for that individual. On the one hand we have Charles, a man with a physical disability who has always wanted to fly in a helicopter – he was immensely proud and happy to do this.

On the other hand, we have Paul, who had never interacted with any of his peers, up until this moment when the staff team managed to capture a spontaneous game of catch with a fellow resident. Paul appeared to be as equally proud and happy with his achievement. I think it is fair to say that the staff team supporting him were too. This incredible achievement could very easily have been overlooked or not captured if it hadn’t had been for the strong person focused culture within that home.

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