Q. I currently have a ‘Good’ CQC rating. How do I improve on that to become ‘Outstanding’?
A. Karen Carter, Programme Head – Leadership and Management, Skills for Care
If you’re a business owner or registered manager, ‘How do I get an Outstanding rating?’ is a question you probably ask yourself fairly often. Following the hard work and dedication it takes to achieve a ‘Good’ Care Quality Commission (CQC) inspection rating, many leadership teams then turn their attention to achieving ‘Outstanding’.
‘Good’ is what people expect from a service. ‘Outstanding’ separates out those who are exceptional.
At Skills for Care, we’re asked for advice on attaining ‘Outstanding’ so frequently that we’re embedding it into our programmes, products and services to set others on a similar path to success. Examples of how other providers have moved from ‘Good’ to ‘Outstanding’ can form a good basis for an organisation’s own approaches.
An open, blame-free culture
Sonnet Care Homes’ The New Deanery and St Mary’s Court were rated ‘Good’ overall and ‘Outstanding’ for leadership by the CQC in 2016. Things were very different in 2014, when one site was the subject of a Panorama documentary focusing on abuse of older people in care settings.
At the time, Sonnet had just become new operators of the care homes. They acted quickly, suspending staff, reviewing their management structure, increasing their training and improving their auditing and oversight services.
Julia Clinton, Chief Executive of Sonnet Care Homes, said there was a culture in the homes that was corrosive, describing it as ‘in the brickwork’. ‘Everyone felt powerless, like they had no voice – frontline workers, relatives and, most importantly of all, residents.’
Since then, this atmosphere has been transformed by improving communication between staff, residents and relatives. Leaders are now present at all new staff inductions and make time to talk to all staff, including those working nights and at the weekend. Suggestion boxes have been installed and surveys of residents’ views are regularly conducted. Monthly meetings are also held between residents and staff.
Julia continued, ‘Sweeping away all barriers to communication creates a culture of openness that has to be present if you want care to be the best that it can be. It’s the thousand little things that happen every day that make the difference.’
Registered managers who are visible
CQC inspection reports have revealed that there are organisations providing care in which leadership teams are practically invisible to staff, residents and relatives.
It’s vitally important that leaders and managers are accessible and regularly visible in day-to-day operation. This is not just about care homes, as managers within community services should equally be known by the people who use the service and their family members.
When the CQC awards an ‘Outstanding’ rating in any category, it needs to evidence why it has done so. Often, this is demonstrated by what people receiving care describe as ‘the extra effort’ leaders and managers make in supporting their day-to-day care provision. For example, a resident of one ‘Outstanding’ care provider said it gives them happiness to see the registered manager on a regular basis. ‘The registered manager is always walking around the service asking us how things are going. They join in with all the activities, and really care about the staff.’
Another resident described the extra input by the leadership teams across the festive period as particularly heart-warming. ‘The management team and the owner can be found talking and sharing a laugh with all who live there, as well as being found cooking the Christmas dinner!’
Visible registered managers promote a culture of teamwork and a strong work ethic through their presence. This inspires and encourages frontline care staff. One care worker from an ‘Outstanding’ rated provider said it means she enjoys her job. ‘You know that they will go to the ends of the earth to make just one small difference to improve people’s lives. It makes me happy to come to work.’
A committed management team
Management teams are there to support their staff, so that staff can support those who need their services. Ineffective management teams can leave staff feeling stressed and disenchanted.
Julia Clinton from Sonnet Care Homes explained that their commitment to overhauling their services is responsible for their success. Julia and her colleagues committed themselves to an ambitious culture change strategy and then set about embedding it in their organisation. ‘Our first step was to develop a set of values for the homes that would be at the core of everything that came next. Kindness, comfort and respect became our mantra. We worked with staff so that they knew what kind, comforting and respectful care looked like in practice, not just in theory.’
High recruitment standards
Recruiting the right people is key to the success of any ‘Good’ or ‘Outstanding’ rated care provider. It is rare to find an inspection report from such an organisation that does not mention effective recruitment practices.
Kevin Hewlett, Director and Registered Manager of ‘Outstanding’ rated Hale Place Farmhouse, said, ‘If we were to drop recruitment standards to fill vacancies, our person-centred culture would become a part-time objective and an enormous burden on the registered manager and person in charge of each shift. We take time to recruit care workers who smile and have a humanistic approach to care.’
He also mentioned their commitment to retention and the happiness of their staff as a factor in their ‘Outstanding’ rating. ‘We look at our staff objectives, aims and goals and support them to achieve, even if that means developing them into roles outside our organisation. The benefits are wide-ranging – they feel valued, supported and are happier.’
Strong links to the local community
Working in social care is so busy, it’s easy to stick within your own little bubble, but ‘Outstanding’ rated organisations tend to have strong links with healthcare professionals, other care organisations and other experts.
Vida Healthcare, an ‘Outstanding’ rated organisation in Harrogate, regularly appears on its local radio station to talk about social care issues facing the local community and promote quality care.
Some of the best ways to stay connected with the local community is to invite people into your premises, arrange events and use local media. You can also invite people to social events or meetings on a more regular basis. One provider explained that ‘Relatives and family members are warmly welcomed and frequently attend our social events. Here, barriers are broken down, relationships are developed and trust is cemented.’
Everybody likes to be celebrated – to be told that the work they are doing and the effort they put in means something. No matter what the rating of your organisation, it’s important that you continue to applaud and reward staff who are working hard and in the way that you want them to.
There is nothing to stop you celebrating your achievements locally, too. If you receive a ‘Good’ or ‘Outstanding’ rating or you have turned your service around, why not contact your local media and sing the praises of your staff?
A news story would promote your services, provide you with evidence of celebration for the CQC and make your staff proud. One care home we spoke to said praise from outsiders was special to their team. ‘It always holds more weight when praise comes from outside observers. Staff could not quite comprehend the small percentage of homes that had achieved “Outstanding” – it made them more proud to be part of it.’
When Vida Healthcare won a Skills for Care Accolade in 2016, the management team contacted their local press and received a letter from their local MP. ‘We plastered it all over our website. We plastered it all over Twitter. Our local newspaper put it on their Twitter account. We were in the Guardian. We were congratulated personally by the CQC and the Head of Skills for Care. I had a member of staff come up to me to talk to me about how they felt and she said, “I am so proud to be part of this company”.’
Do everything well
There is no instruction manual for ‘Outstanding’ ratings. Organisations that are rated ‘Outstanding’ are most likely doing everything well, including learning from mistakes to improve their practice.
It seems like an overwhelming task in a sector that is struggling with financial difficulties and a bad reputation, but it’s achievable. Although it’s incredibly rare for an organisation to be rated as ‘Outstanding’ across all five categories, it does happen. The important thing to remember is that you should be trying to provide the highest quality care for those using your services, at all times. If you’re working towards that with a strong team, you’re probably on your way.
Registered managers can have a direct impact on the rating of your service. The ‘Well-led’ category is the most closely aligned to all other categories. Those organisations rated highest for being ‘Well-led’ tend to get higher ratings overall.
Skills for Care is embedding the knowledge we’ve learned from ‘Outstanding’ care providers into a leadership programme beginning this autumn. The Skills for Care Well-Led Programme is grounded in the reality of social care delivery. It provides the opportunity to develop leadership skills, make valuable advances in the service and have real impact in the workplace.
It includes details of what ‘Well-led’ organisations do to achieve and sustain high standards of leadership and how to apply these examples across your own organisation to deliver high-quality, person-centred care.
Although there can be a big leap from ‘Good’ to ‘Outstanding’, by learning from others, you have tried and tested approaches to try.