Registered Managers Forum December 2016

Outstanding Less than 1% of care homes in England have been given an Outstanding rating by the CQC 75% of the 115 Outstanding care homes are, in fact, Outstanding in only 2 out of the 5 questions and "only" Good in the other 3. Only 3 homes are totally Outstanding across all 5 questions The South East and South West regions have nearly half of all Outstanding care homes, against a 33% share of all care homes in England Only 38% of local authorities can boast an Outstanding home within their area. Warwickshire has nearly 9 times as many Outstanding homes across all its homes than the national average There are 9 care groups who account for 22.5% of all Outstanding Ratings – but only account for 0.4% of all care homes.

New inspection ratings – Surrey (allowing for vagaries of CQC website) Total 614 Good  (393) 64% Requires improvement (150) 25% Not rated  (42) 7% Outstanding  (10) 2% Inadequate  (11) 2% Rating Care Home Nursing Home Dom Care Outstanding 6 1 3 (1 Agency, 1 Care Home, 1 Hospice) Good 171 63 59 Requires Improvement 70 51 17 Inadequate 4 7

Care Homes – Well led Concern areas The provider did not have systems in place to regularly assess and monitor the quality of the service the service provided. The provider had not met breaches in regulation from the previous inspection. The provider failed to seek, encourage and support people's involvement in the improvement of the home to improve the quality of care. Staff and the provider were not following their own policies and procedures in relation to care. We could not effectively monitor what was happening in the service as notifications were not always sent to the CQC. The service had recently experienced significant changes to the leadership of the home which needed to be embedded and sustained. The appointment of a new registered manager is crucial to this process. Although care plans were not always up to date this did not impact the care people were receiving. We have recommended that improvements continue to be made. The provider’s did have systems to quality monitor the service and care although these had not always identified shortfalls. We have recommended that further improvements are made. The provider did not have robust processes that had ensured people finances were managed appropriately.  The registered provider had not maintained appropriate procedures in relation to people’s personal finances. As such conditions to their registration had been imposed.

Domiciliary Care – Well Led Concern Areas Robust systems were not in place to ensure ongoing monitoring of the quality of service delivery and ensure learning from incidents and complaints. The systems in place for quality assurance required improvement to fully ensure the quality of service provided. People did not know who the registered manager was. People and their relatives thought that the co-ordinators were approachable and supportive. There were not robust systems in place to monitor the quality of care provided. There was a system in place to obtain feedback from people, however they were not always used within providers the stated timeframe. Record keeping was inconsistent, there were gaps in some people’s records and care plans. The use of paper and computer records meant information was sometimes missing, inaccurate and not always up to date.

Most people are receiving good care – but strong leadership and collaboration are crucial to facing challenges ahead David Behan CQC Despite increasingly challenging circumstances, the majority of services across health and social care have been rated as good, with some rated outstanding. However, there is significant variation in quality - and safety continues to be the biggest concern across all the sectors that CQC regulates. Strong leadership and collaboration is emerging as more crucial than ever to delivering good care.

”some insights on the role of leaders: Our inspections have identified strong leadership as a crucial factor among those providers rated as either good or outstanding. More than nine out of 10 (94%) of the services we have rated as good or outstanding overall are also rated as good or outstanding for their leadership. Similarly over eight out of ten (84%) of the services we have rated as inadequate overall were rated inadequate for leadership. Leadership – at all levels – is key not only to running a successful organisation, but in turning around a failing one; the ability to recognise a problem, coupled with the ability to change.  “In the continued and sometimes heated debate about how to provide safe, high-quality and compassionate care, the importance of good leadership shines through.”  ”some insights on the role of leaders: People – leaders listen, inspire and motivate Planning – leadership is doing the right thing at the right time Delivery – we need to be clear about what we are doing, how, who is doing it and when” Andrea Sutcliffe

Outstanding care homes share three common attributes: They have an outstanding manager who is well supported and valued.  They have sufficient resources to do the job well and these resources are invested in the service. An outstanding care home wholly reliant on state funding is an incredibly rare thing.  The provider organisation’s values and ethos are clear and effectively translated from the board room to the floor of the care home. Profit is never the raison d’être of these care homes. 

Leadership And the support from the organisation

Well Led

Well Led – Common Features Remarkably Consistent Comments/Themes in Reports

QA Processes Partnership Effective Communication (Sharing Vision/Values) Clarity of Roles Visibility Feedback from others (Staff, Proffs, relatives) Leadership, Caring, Listens Seeking Feedback Outward Looking Awareness of & Following Best Practice Guidance Consultative/Involving Others Role Model Accreditation QA Processes Open Transparent Culture Focus on Improvement

Now on SfC Website The seven Dimensions within the Framework are: 1 Demonstrating personal qualities 2 Working with others 3 Managing services 4 Improving services 5 Setting direction 6 Creating the vision 7 Delivering the strategy Now on SfC Website