1. Adult Social Care – Next Phase
Paula Eaton
27th February 2017 1 1

2. Assessment Framework changes:
Evolution, not revolution
Same structure: Key Questions, KLOEs, Characteristics of Ratings
Strengthen
Based on learning & and changes in the sector
Not ‘raising the bar’ for providers
Enable providers to show how they are developing and adapting
Simplify
Aligning the questions we ask the different sectors & services
Promote idea of a single shared view of quality
A simpler process to reduce regulatory burden on providers 2

3. Key changes – important themes
Caring strengthened to include resources, time and support for staff to work with individuals in a compassionate way
More open KLOE questions (Do & Are? to How?)
Information sharing, governance and data security
Technology (risks and opportunities)
Medicines KLOE strengthened
EDHR strengthened
Even bigger focus on personalisation
Support to live healthier lives 3

4. Key changes Assessment Framework
Some key changes for Adult Social Care:
Safe – support for people when behaviour challenges: Moved from Effective
Effective – processes to ensure no discrimination: Moved from Safe
Effective – organisations working together: Moved from Responsive
Effective – staff working together across organisations Moved from Responsive
Responsive – supporting people at the end of their life Moved from Caring 4

5. Key Changes for ASC Five New KLOEs
S1 How do systems, processes and practices safeguard people from abuse?
S6 Are lessons learned and improvements made when things go wrong?
E1 Are people’s needs and choices assessed and care, treatment and support delivered in line with current legislation, standards and evidence-based guidance to achieve effective outcomes?
W2 Does the governance framework ensure that responsibilities are clear and that quality performance, risks and regulatory requirements are understood and managed?
W3 How are the people who use the service, the public and staff engaged and involved? 5

6. Eleven Changed KLOEs (1)
Key Changes for ASC
S2 How are risks to people assessed and their safety monitored and managed so they are supported to stay safe and their freedom is respected?
S4 How does the provider ensure the proper and safe use of medicines?
E2 How does the service make sure that staff have the skills, knowledge and experience to deliver effective care and support?
E5 How are people supported to have healthier lives, have access to healthcare services and receive ongoing healthcare support?
E6 How are people's individual needs met by the adaptation, design and decoration of premises?
C1 How does the service ensure that people are treated with kindness, respect, and compassion, and that they are given emotional support when needed? 6

7. Eleven Changed KLOEs (2)
Key Changes for ASC
C2 How does the service support people to express their views and be actively involved in making decisions about their care, support and treatment as far as possible?
C3 How is people's privacy, dignity and independence respected and promoted?
R2 How are people’s concerns and complaints listened and responded to and used to improve the quality of care?
W1 Is there a clear vision and credible strategy to deliver high-quality care and support, and promote a positive culture that is person- centred, open, inclusive and empowering, which achieves good outcomes for people?
W4 How does the service continuously learn, improve, innovate, and ensure sustainability? 7

8. Aggregation principles
The five key questions are all equally important and should be weighted equally when aggregating
All ratings will be treated equally for the purposes of aggregating unless one of the other principles below applies
 At least two of the key questions being “outstanding” with the remainder of the ratings being “good” aggregates to an overall rating of “outstanding”
At least two of the key questions being “requires improvement” aggregates to an overall rating of “requires improvement”
If one of the key question ratings is “Inadequate”, the overall aggregated rating cannot be higher than “requires improvement”
At least two of the key questions being “inadequate” aggregates the overall rating to “inadequate”

9. Well-led limiters
The four principles below show events and circumstances that mean that the well-led question can never be rated better than “requires improvement”
The location has a condition of registration that it must have a registered manager but it does not have one, and satisfactory steps have not been taken to recruit one within a reasonable timescale
The location has any other condition of registration that is not being met without good reason
Statutory notifications were not submitted in relation to relevant events at a location without good reason
The provider has not returned the PIR or contact information, where requested by CQC, or supplied the information in another format as agreed in advance. Providers should have this information readily available to them through the internal systems they are required to have to monitor and improve the quality of their service.

10. Rating and reporting on locations with a breach - ASC
A provider with a breach cannot be rated as Good.
Providers rated as good are meeting the standards set out in the regulations and display the characteristics of good care (i.e. to be rated good means more than just meeting the standards set out in the regulations) [CQC enforcement policy p9]
Inspectors should use their judgement about whether an incident constitutes a breach of regulations in the normal way, taking into account the impact on people, the history of the service regarding any previous incidents it has had and how it responded to them. Where an incident has a low impact, inspectors should consider the proportionate action to take - this may include making a recommendation - and reflect this in their report.
Our ratings must be proportionate to all of the available evidence and the specific facts and circumstances

11. Repeat Requires Improvement
Ongoing monitoring informs inspection planning
Letter stating subsequent RI may be considered breach of Regulation 17
Enforcement action
Consider improvement action plan
Meet with provider, registered manager and commissioners

12. Focused Inspections Based on risk
Always look at Well Led and other domains where there has been
a breach or risk identified.
6 month limit for overall rating change abolished
Expand to comprehensive inspection where necessary
Next comprehensive inspection only brought forward where rating
worsens after focused inspection

13. For a good service to be rated outstanding
..there are additional key characteristics that make the service exceptional and distinctive

14. 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 those values inspire staff
A can do, will do attitude – staff dedication
Strong links with local community
Safe care actively promoted – effective oversight of care and staff communication

15. Top tips for achieving an outstanding rating
Set out your ambition to be outstanding – It has to start at the top
Involve staff, residents, their relatives and other health professionals in developing strategies to help you achieve your ambition
Determine where you are now and identify the gaps you need to plug
Can you easily identify the outstanding features in your home? Will your staff, residents, other health professionals support your view?
What makes a difference between good and outstanding is often how the service pays attention to detail – simple things done well that have a significant impact on the people using the service
Think about how you will sustain high quality performance
Work hard on ‘your’ ability to demonstrate the impact your intervention is having on people. Ask yourself whether people, their relatives, staff and other professionals will corroboration your assessment of your quality when asked.

16. Paula Eaton, Inspection Manager
Thank you
@CareQualityComm
Paula Eaton, Inspection Manager