CQC Update Paula Eaton 2nd November 2015 Generic ASC deck (June Final)

Adult Social Care Vision The Mum Test Is it safe? Is it caring? Is it effective? Is it responsive to people’s needs? well-led? Is it good enough for my Mum?

Responsive to people’s needs? Well-led? Asking the right questions about quality and safety Safe? Effective? Caring? Responsive to people’s needs? Well-led? 3

Five key questions Safe By safe, we mean that people are protected from abuse and avoidable harm. Effective By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is evidence-based where possible. Caring By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect.

Five key questions Responsive By responsive, we mean that services are organised so that they meet people’s needs. Well - led By well-led we mean that the leadership, management and governance of the organisation assures the delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture.

Inspection Process Prior to Inspection Information held by CQC including PIR Contact with key stakeholders Inspection Single inspector or team Seeking the views of people and their families/friends Observations Talking to staff Looking at records Reporting Enforcement Action

Duty of candour Purpose Actions for providers CQC Promotes adoption of openness and transparency in services Supports development of safety culture Actions for providers Inform people when things go wrong Provide support, truthful information & apology CQC Registration Inspection – existing key lines of enquiry Providers must be open and honest with people when things go wrong with care and treatment. Providers must give them reasonable support, truthful information and a written apology. Providers must have an open and honest culture at all levels and have systems in place for knowing about notifiable safety incidents. The provider must keep written records and offer reasonable support to the patient or service user in relation to the incident. A requirement to be candid is already in the NHS contract so, in theory, NHS trusts should already be fostering a culture of openness and honesty. The duty of candour means CQC can take enforcement action against services that don’t satisfy these requirements.

Special measures Purpose Actions for providers CQC Ensure failing services improve or close Actions for providers Use time available to improve service CQC Services rated as inadequate will go into special measures Time limited period to improve Improvements made – out of special measures No improvement – move to cancel registration Does not replace enforcement action Generic ASC deck (June Final)

Scores on the doors Purpose Actions for providers CQC Public able to see rating of service quickly and easily Actions for providers Display ratings in service and website Suggest accompany with additional information CQC Will provide template Inspection – check that rating is displayed Generic ASC deck (June Final)

Four point scale High level characteristics of each rating level Innovative, creative, constantly striving to improve, open and transparent Consistent level of service people have a right to expect, robust arrangements in place for when things do go wrong May have elements of good practice but inconsistent, potential or actual risk, inconsistent responses when things go wrong Severe harm has or is likely to occur, shortfalls in practice, ineffective or no action taken to put things right or improve 10

Adult Social Care services Latest ratings at 26 October 2015 Adult Social Care services 44 (<1%) Outstanding 5130 (59%) Good 2963 (34%) Requires Improvement 584 ( 6%) Inadequate 8721 Total 11

Examples of Good Person Centred Care ‘There were a range of risk assessments including support for a person with behaviour that challenged the service, and strategies to assist a person to understand why they should adhere to medically advised healthy eating guidelines while recognising the person’s individual rights and preferences. This showed that the service strived to promote people’s independence, taking into account the need to minimise risks to their safety’. ‘The rotas showed that although the service was not sure how long the person would remain an in-patient; the deputy manager had made provisional short-term arrangements for the person to have a staff member at their bedside every day, in accordance with their needs’. 12

Examples of Good Person Centred Care ‘Staff knew people very well and were in tune with peoples‘ needs by adjusting the care they provided. For example, we observed a member of staff supporting a lady with dementia to eat very well. The member of staff spoke to her and adjusted her speed well to accommodate the person. The staff member understood when the person wanted a drink noting that the lady’s eyes changed’. ‘One person with particular mobility difficulties had wanted to go out to a concert. We saw staff had obtained and altered a piece of equipment so that this person could go on the outings of their choice’. 13

Examples of Good Person Centred Care ‘There were colour changes to floors and walls, pictorial signage and personalised front doors to assist people to recognise where they were’. ‘The staff also held a weekly ‘farmers market’ in the dining room…..We saw that a variety of fresh food was displayed and the services housekeeper spoke with people about what food they would like and would cook an individual meal if needed. For example, one person attended the farmers market and saw a pork chop. They remembered how they used to always cook a pork chop for their partner. The staff then cooked an individual pork chop meal for that person’. 14

Examples of Good person Centred Care ‘Understanding peoples' interests and hobbies was key to providing person centred care in the home. One person has been involved in teaching other people how to paint as teaching was their background’. ‘The plans included people’s likes and dislikes and what was important to that person. For example the plan for one person stated it was important that their day clothes were coordinated and they wore make-up’. 15

Examples of Good person Centred Care ‘One person told us that their girlfriend lived at another service managed by the provider and they saw each other regularly. Staff confirmed that they were consulting with the person and their girlfriend in order to help plan a European holiday, in accordance with their wishes’. 16

Examples of Good Person Centred Care ‘Staff were given the opportunity to build meaningful relationships with people and ample time to meet people’s needs and provide companionship’ ‘The activities encouraged people to test their physical and mental dexterity as individuals and groups and enabled people to share their life skills and experiences. Peoples comments included, “It’s amazing, just lovely”. 17

Examples of Good Person Centred Care ‘We saw evidence that a person whose family had brought them from abroad for one last visit had been taken ill on their visit and received care in Cheviot Nursing Home. The support provided to the person, their family and their extended family had been described by the family as, ‘….nothing but outstanding.’ ‘This was demonstrated by people having the opportunity to invite friends and relatives into their home for a private dinner party. A notice on the wall advertised this experience with the following wording, ‘Would you and your loved ones like to like to enjoy fine dining at Cheviot under the stars or in your own room. Your choice of menu for a two course meal special occasions catered for.’ 18

Examples of Good Person Centred Care ‘Every aspect of peoples' experiences in the home were delivered to the advertised care philosophy of being Supportive, Personal, Attentive, Relationship Centred, Kind, Listening and Enabling or SPARKLE’. ‘People using the service and their representatives had been invited to attend a three day event organised by the provider. Its’ purpose was to consider the future development of the organisation. The results of the most recent questionnaires showed that people were happy with the quality of care and support’. 19

People are at the Heart of It 20