Business Clinic
5 Outstanding…and counting

WCS Care is the first care home provider in England to achieve five ‘Outstanding’ quality ratings from the Care Quality Commission (CQC). How has it achieved this and can others follow in its footsteps?

WCS Care is a not-for-profit care provider operating 12 care homes across Warwickshire. Ten homes offer day care, long-term residential and short-term respite care for older people and people living with dementia or a range of different needs – three of which have now been recognised as ‘Outstanding’.

The other two homes provide rehabilitation, respite and residential care for younger adults with physical disabilities or long-term conditions – both are also recognised as ‘Outstanding’.

Outstanding homes

The first WCS Care home to be recognised as ‘Outstanding’ was Drayton Court in Nuneaton. It was rated ‘Outstanding’ in the ‘Responsive’ and ‘Well-led’ categories, and ‘Good’ in the other three categories: ‘Safe’, ‘Effective’ and ‘Caring’. Commenting on the ‘Outstanding’ areas, the inspectors said, ‘The registered manager and staff were flexible and responsive to people’s individual needs and preferences and ensured people were enabled to live as full a life as possible.

‘People were encouraged to build and maintain links with their community by taking part in local events and by inviting people and organisations to visit. The registered manager had been interviewed by a local newspaper and had taken the opportunity to explain the vision and values of the home, and to invite volunteers to get involved.

‘Relatives and staff told us the managers were approachable and supportive and the registered manager operated an open and listening culture. A visitor told us, “This is great, really impressive. It’s a nice place to be. I enjoy visiting.” A member of care staff told us, “The manager is very approachable, I love working here, we are a very close-knit team.” The provider’s vision and values were imaginative and person-centred and put people at the heart of the service.’

Dewar Close in Rugby also received an ‘Outstanding’ rating in ‘Responsive’ and ‘Well-led’ leading to an overall rating of ‘Outstanding’ (with ‘Safe’, ‘Effective’ and ‘Caring’ rated as ‘Good’). Commenting on the ‘Outstanding’ areas, the inspectors said that ‘people’s preferences, likes and dislikes were understood by the staff from the person’s point of view’ and that WCS Care’s ‘philosophy, vision and values were shared by all the staff, which resulted in a culture that valued people’s individual experiences and abilities’.

Attleborough Grange followed Drayton Court with its ‘Outstanding’ rating on 7th May. This home received ‘Outstanding’ in the ‘Caring’ and ‘Well-led’ categories and ‘Good’ in the rest. The inspectors said of the ‘Caring’ category, ‘The service was very caring. People and relatives told us there was “something” in the atmosphere that made them feel welcome and truly “at home”. People, relatives and a visitor told us the care and support they received exceeded their expectations. They told us they were surprised and delighted at the level of kindness, thoughtfulness and compassion shown by staff.’

Mill Green in Rugby became the charity’s fourth home to be recognised as ‘Outstanding’ by the CQC. The home provides rehabilitation, respite and residential care for people with physical disabilities or long-term conditions. Mill Green achieved ‘Outstanding’ in ‘Effective’, ‘Caring’ and ‘Responsive’.

The CQC report said residents at ‘were at the heart of the service’ and that the team ‘understood the importance of being partners-in-care with people who lived at the home’. It also recognised that the team ‘took time to understand people’s histories and dreams and encouraged them to be ambitious in making decisions about their day-to-day lives’, and how they treated ‘people’s right to choose how to live their lives’ among the highest priorities.

One resident told the inspector that they were initially anxious about moving into a care home but were ‘overwhelmed’ by the team’s ‘understanding, thoughtfulness and willingness to support them to regain control of their day-to-day life’.

The CQC also highlighted the positive impact activities like Oomph! Wellness and gardening had on the lives of people living at the home and stated ‘people and staff share the moment of fun together, which develops trust and positive relationships’.

Fifth outstanding

The final home to be recognised as ‘Outstanding’ was Newlands in Kenilworth. This was achieved in October. Again, a home for people under 65, it offers rehabilitation, respite and residential care for people with physical disabilities or long-term conditions. Its ‘Outstanding’ categories were ‘Caring’, ‘Responsive’ and ‘Well-led’.

Residents told the inspector that ‘their lives had improved and their horizons had broadened since coming to Newlands’. The report included examples of how the team encouraged independence at Newlands, so that people could ‘carry on with their working lives or continue their education’, including a resident who works for a local car company and another who works for a recycling charity.

Jason Saunders, who has lived at Newlands for over 10 years, said, ‘Newlands is an outstanding place to live because it is my home. I’m able to live my life how I want to and do the things I want to do – anything from working in the garden to fixing a bike or going to the pub with friends.

‘The team here are great and are very supportive – they help make it a fun, caring place to live and I’m really pleased that my home has been recognised.’

The CQC also highlighted the use of ‘creative communication techniques’ including an electronic touch and voice activation system designed to be used alongside other signs and gestures, as well as encouraging the use of other technology, such as digital screens and social media, to keep in touch with relatives around the world.

Going the extra mile

Commenting on the company’s fifth ‘Outstanding’, WCS Care Chief Executive, Christine Asbury said, ‘In every WCS Care home, our teams always go the extra mile to provide the highest quality care because that is the way we think it should be done…we won’t be resting on our laurels – we’re always keen to push the boundaries of innovation and find new ways of responding to the ambitions of residents, so that every day is a day well lived.’ CMM

Over to the experts…

What WCS Care has achieved is ground-breaking. To be awarded five ‘Outstanding’ quality ratings must be commended. However, is this achievement only possible for the larger providers with economies of scale? Or does that make it harder to achieve consistency with more homes to manage? Is it easier for not-for-profit providers to achieve ‘Outstanding’? Can other providers learn from WCS Care? What does the panel think? 

Difficult, but not impossible to achieve

So far, only about 1% of services have received an ‘Outstanding’ rating from the Care Quality Commission (CQC), so the achievement of WCS Care in having five of its services awarded this accolade is pretty amazing. It is a real credit to the way in which the organisation has transmitted its core values and made sure that these are being delivered across its services.

I think it’s important to remember that whether you are part of a large group, or an individual service, the CQC will rate you on the basis of what each individual service delivers to the people who use it.

However, I think there are some common themes which come through all of the services that have been rated ‘Outstanding’. First, there is a rigorous focus on the needs of the people who use care, and their families.

This focus manifests itself in services that are responsive and flexible and give people a good-quality life, rather than just a service.

There has been a lot of talk as to whether or not some services are more likely to be rated as ‘Outstanding’ than others, and I have seen commentators suggesting that voluntary sector services, or small units, are the ones most likely to receive an ‘Outstanding’ rating.

Care England is supporting an ‘Outstanding’ Group of providers and this has got a mixture of charitable and commercial providers, larger and smaller services; services for older people, as well as those for people with learning difficulties. The diversity of this group shows clearly that with the right values, highly-motivated staff, and a rigorous commitment to delivering high-quality lives for the people who use services, any service should be able to aspire to, and achieve, and ‘Outstanding’ rating.

Professor Martin Green OBE, Chief Executive, Care England 

Going back to the roots of care

WCS Care’s recurring ‘Outstanding’ themes focus on involving people in their own support, promoting independence, respect for choices, involvement in the local community, the stability of the staff team and a leadership focused on improvement. Judgements are focused on the care being delivered and relationships that are built; going back to the roots of care. It is rarely about paperwork, meeting regulations or systems.

WCS Care also supports younger people and transferring this model to older people’s services increases chances of an improved rating, as highly-developed person-centred care is the norm for younger adults. Although, in some cases this model is ‘finding its feet’ and a challenge in some isolated older people’s services.

If providers want an ‘Outstanding’ rating, they need to ‘sell themselves’ during an inspection. They need to be upfront, prepared, proactive, engaged and change the dynamic; treat the inspector as a potential client. The regulator also needs to be more proactive and seek evidence to support really good practice, and not be afraid of rating services accordingly.

Published figures show that the percentage of ‘Inadequate’ services is significantly reducing, the number ‘Requiring improvement’ is also reducing and ‘Good’ services are increasing. However, services rated ‘Outstanding’ appear to be fixed at around 1%. This may lead to it being seen as unachievable and a disincentive for improvement. I believe that more  than 1% of services are ‘Outstanding’, and if so, then it must lie with how evidence is presented, looked for, judged or included in inspection reports. This 1% figure is a block for inspectors too. As it is so ‘rare’ it is in danger of overriding the judgement process, which should be objective and based on evidence.

Ed Watkinson, Director of Care Quality, Quality Compliance Systems 

All providers should be studying ‘the best’

There can be no doubt that an organisation having five care services rated by Care Quality Commission as ‘Outstanding’ is an outstanding achievement in itself. Also, achieving ‘Outstanding’ in five out of 12 care services is tremendous and must be a great fillip to all involved at WCS Care.

It seems likely that many variables will have contributed to such consistent demonstrations of ‘Outstanding’ quality.

These variables include, but aren’t limited to, genuinely listening to what people who receive the service have to say about it, along with their families and staff; leaders who maintain the high standards through the way they work; a culture of openness and transparency; investing in training and development to support and motivate frontline staff; and meaningful activities for people living within care settings.

There is probably also something to consider around assisting staff in how they evidence what they do to meet the needs of the people they support. In other words, taking the inspection and assessment of a care service seriously.

Such factors are not, in my view, the preserve of bigger providers or not-for-profit care providers per se. I believe that a commercial approach is necessary for reinvestment and sustainability.

Shared learning is certainly the key to increasing the number of providers achieving an ‘Outstanding’ rating. All care providers with an interest in delivering quality improvement, whatever their size, approach and type of service, should be studying other ‘Outstanding’ providers, ‘the best’, to learn what they can do better.

Des Kelly OBE, Chair, Centre for Policy on Ageing 

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