What does it take to gain an outstanding rating form the CQC?

Herefordshire Care Homes owner and CEO Karen Rogers boasts the enviable record of having five out of her six care homes rated ‘outstanding’ by the CQC. So, it may be useful to managers that Karen is willing to share her recipe for success.

Upgrading of care homes Karen acquired her first home in Herefordshire 20 years ago. Since then she has grown the business through the purchase of five more existing properties.  She found that the homes were all trading as care homes with some quite old-fashioned practices and quite institutionalized models of care. Part of the transformation of the homes was upgrading them to provide a more welcoming and spacious environment. Karen added 17 en-suite rooms to her first acquisition as well as remodeling the existing property, this expansion and redevelopment was replicated in each of the other homes. "I think it’s really important that nobody’s standard of living falls when they move into a care home. It’s important for me that people live in a really nice environment."

Culture The biggest challenge to Karen was Changing the culture in order to get to providing the level of care that she wanted. The turnaround was through a combination of training existing staff and bringing in key people who share a vision of well-being. One of the many innovations Karen employs to ensure that staff buy-in to her values is getting managers to live in the care home as a resident for a day. “They have to rely on staff for everything – for their nutrition, hydration and social interaction,” she said. Following the day, a feedback session is held with the management team to discuss how it feels to be in a home and how disempowering it can be. Karen’s services have developed a model of care that is really just about people changing their address. She wants people to live in a care home because they can continue to live well. People are really busy living their lives no matter how frail they are. Even the frailest are out living their life and functioning really well. We’ve seen so many people whose frailty has been reversed due to a model that focuses on good health.”

Staff Staff like working in a model of care that reflects the way they would like to live themselves. They are really motivated to help people do the things they would like to do themselves. Staff talk about empathy all the time and they are really proud of what they do. They just absolutely love making sure people have a great life. Staff are further motivated through a range of incentives, including annual awards.

Activities Karen has completely changed the way activities are provided in her homes. There are no standard activities. Residents are able to choose their own entertainment, such as house concerts, and invite their relatives and friends along to experience it with them. People are engaged in a whole range of things such as yoga, swimming, theatre groups and outdoor activities such as gardening or participating in a walking group. Each evening people choose how they spend their time, from watching films with a glass of wine or just socialising with others.

Assessments Staff carry out an assessment on each resident when they come into a home to predict the likelihood of a hospital admission, based on their GP summary. Measures are then put in place to prevent that happening. "We have seen a drastic fall in admissions and a real improvement in increasing people’s mobility. Every resident has a nutritional assessment and is provided with a range of foods that provide good health, with their nutritional and hydration intake monitored closely. Each home employs its own physiotherapist who works with residents on a daily basis."

Inspections The service continually prepares for inspections, ensuring they gather the evidence to support the characteristics of an outstanding service. Focus is all about outcomes and the impact of actions taken. We particularly look at gathering evidence through auditing to show how the things that we do have an impact on people’s lives.

Summary Karen Rodgers has demonstrated to the CQC that she provides outstanding services. Analyses of the elements that lead to outstanding grading which I have covered in this blog should be of interest to managers aspiring to achieve outstanding gradings. Herefordshire Care Homes have invested heavily on the upgrading of their homes and this will be above the resources available to many care homes. That said, managers can do a great deal to improve their services. By far the greatest challenge is to get staff to buy in to a person centred culture with an understanding empathy with service users of their needs. This coupled with good management, sound leadership, a quality management system that meets CQC Standards, an auditing system that continually checks performance and surveys that demonstrate people satisfaction with the service will go some way to outstanding gradings. Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy