OACP Care Providers: CQC Update Chloe Hawkins May 2017

What do the overall ratings mean? Outstanding The service is performing exceptionally well. Good The service is performing well and meeting our expectations. Requires improvement The service isn't performing as well as it should and we have told the service how it must improve. Inadequate The service is performing badly and we've taken action against the person or organisation that runs it.

National overall ratings…. Adult Social Care covers all service types - residential, community, hospices Source: CQC – 1 February 2017

…and by key question Source: CQC – 1 February 2017

National change in overall rating following inspection

And the breakdown?

Oxfordshire overall ratings…. Adult Social Care covers all service types - residential, community, hospices Source: CQC – 22 May 2017

April 2017 Oxfordshire: 73 services which have been rated more than once Note: Figures on chart show percentage of locations Source: CQC ratings data extracted 03/04/2017

ASC Oxfordshire: Overall Ratings change from first to last inspection Source: CQC ratings data extracted 03/04/2017

Oxfordshire Key Question summary Overall improvement was positive, with all Inadequate services becoming Good and 55% of services originally rated as Requires Improvement being rated Good on most recent inspection. Caring showed the least change, in line with the general national trend. The Effective domain had the largest proportion of locations improving by a narrow margin (51% vs. next largest improvement of 45%) but also the largest proportion of locations deteriorating by quite a large margin (17% deteriorated on Effective vs. 11% on Caring).

CQC’s internal quality assurance Reports Peer review by another inspector Sign off by inspection manager Overall outstanding go to a regional panel chaired by Head of inspection Breaches of regulation CQC’s ‘Enforcement decision tree’ applied – risk assessment tool to assess the impact and likelihood of re-occurrence which determines the seriousness of the concern. Recommendation as to what enforcement action should be taken. Into and out of special measures All reviewed at a regional panel chaired by enforcement leads

Themes from Well-Led– Inadequate Unawareness of best practice and notifications not being made to CQC Lack of supervision and training opportunities Ineffective systems to identify and manage risks / no process to assess lessons learned Regular management changes / no registered manager Poor care planning / lack of personalised care Closed culture – views not listened to or acted on Underdeveloped partnership working and community links CQC Published reports – sampled for data on well-led. Sample size 177, 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted) for and 127 for services with inadequate ratings for well-led.

Themes from Well-Led– Outstanding People who use services, relatives and staff speak highly of the service Effective monitoring and quality assurance 75% of services had a registered manager in post consistently Open culture – people who use services/ staff/ relatives shared views and issues Good leadership extends beyond the manager and includes the provider A can do, will do attitude Strong links with local community Safe care actively promoted – effective oversight of care and staff communication CQC Published reports – sampled for data on well-led. Sample size 177, 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted) for and 127 for services with inadequate ratings for well-led.

Outstanding characteristics People are at the centre and staff want to give them a life not just a service Good leadership extends beyond the manager and those values are cascaded to inspire staff Open culture – people who use services/ staff/ relatives shared views and issues Strong links with local community 75% have registered manager in post consistently A can do, will do attitude – staff dedication Safe care actively promoted – effective oversight of care and staff communication LAs – How can you commission for these outstanding qualities? How can you manage existing contracts to reach and value services which demonstrate these qualities? The better the relationship between LA and CQC, and the more a LA works proactively in partnership with local providers, the better the quality of care.

Common themes from ‘well-led’: Outstanding “This place is brilliant, management care so much, as do the staff, everybody knows their role and the atmosphere is amazing.” “I’m made to feel important, I’m constantly encouraged to always better myself.” Passion Excellence Integrity Cooperation CQC Published reports – sampled for data on well-led. Sample size 177, 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted) for and 127 for services with inadequate ratings for well-led.

What does this mean for individuals? “I feel safe, I can live the life I want and I am supported to manage any risks” “I am in control of planning my care and support” “I have care and support that is directed by me and responsive to my needs” http://www.thinklocalactpersonal.org.uk/_library/Resources/Personalisation/TLAP/MakingItReal.pdf “I can plan ahead and keep control in a crisis” think local act personal – MAKING IT REAL Marking progress towards personalised, community–based support

‘Outstanding’ can be achieved "We didn't think we were outstanding. And perhaps that's why we were – I think it's because we see every single person as an individual. It is our privilege to support them to live the last years of their life with as much happiness, love and security as we can give them." Suzanne, Prince of Wales House, Ipswich Generic ASC deck (June Final)

management inspire confidence and lead by example Prince of Wales House, Ipswich innovative and creative ‘My Story’ booklets give detailed biography of a person – with the clear message that their lives do not stop when they move into care commitment by managers to continually improve vibrant and friendly environment staff are motivated by a strong culture of inclusivity considers individuals and their views and preferences care is person-centred management inspire confidence and lead by example strong and visible leadership

Out Devon care home rated as outstanding in all 5 key questions http://www.cqc.org.uk/content/cqc-rate-devon-care-home- outstanding-all-areas “Arcot House Residential Home demonstrated that people were consistently at the heart of the service. People living here were clearly seen as part of an extended family where staff know each person well, recognising their individual interests and what mattered to them. Care was provided by an innovative and committed team who looked after people with the utmost dignity and respect." Out

Some thoughts to consider……… Do I have a trusted critical friend, someone independent who will tell me the truth abut my service? Do I really know what care users think about the care and attention they receive? Are my staff really clear about our visions and values? Do I have ways in which to encourage and support my staff to try out innovative ideas? How do I value and support my staff?

CQC’s ambition Our ambition for the next five years: A more targeted, responsive and collaborative approach to regulation, so more people get high-quality care We’re on the way to completing inspections of all the services we regulate, giving us a unique baseline understanding of quality. When we’ve finished, the next step isn’t simply to start again, but to use what we’ve learned (and what people tell us) to target our inspections where poor care, or a change in quality, is more likely. So the new strategy sets out the next stage of our journey - it sets out an ambitious vision for a more targeted, responsive and collaborative approach to regulation so more people get high quality care. It has been developed based on what thousands of people, providers, staff and partners have told us and what we have learned from over 22,000 inspections. 22

Four priorities to achieve our strategic ambition Encourage improvement, innovation and sustainability in care Deliver an intelligence-driven approach to regulation Promote a single shared view of quality Improve our efficiency and effectiveness 1. Encourage improvement, innovation and sustainability in care – we will work with others to support improvement, adapt our approach as new care models develop, and publish new ratings of NHS trusts’ and foundation trusts’ use of resources. 2. Deliver an intelligence-driven approach to regulation – we will use our information more effectively to target our resources where the risk to the quality of care provided is greatest and to check where quality is improving, and we will introduce a more proportionate approach to registration. 3. Promote a single shared view of quality – we will work with others to agree a consistent approach to defining and measuring quality, collecting information from providers, and working together towards a single vision of high-quality care. 4. Improve our efficiency and effectiveness – we will work more efficiently, achieving savings each year, and improving how we work with the public and providers.

Remember why we do this…… Copyright: Community Care