The Care Quality Commission has recently published a report entitled ‘The State of Adult Social Care Service 2014 to 2017; Findings from CQC’s initial programme of comprehensive inspections in adult social care’. The report contains conclusions published by CQC between October 2014 and May 2017 of 33,000 inspections it had undertaken of adult social care providers at 24,000 different locations.
Almost four-fifths of adult social care services in England had been rated by CQC as good (77%) or outstanding (2%). A fifth of services were rated as requiring improvement, with 343 locations (2%) rated as inadequate.
In this article we focus on the regulator’s own analysis of its inspection findings over the period, with particular focus on the characteristics which CQC has identified as having led to high quality and poor quality care.
Factors identified by CQC as leading to high quality care
Leadership: CQC recognises that good leaders, both at registered manager and provider level, have a pivotal role in highperforming services and bringing about improvement in adult social care; in creating a supportive environment for staff, listening to their concerns, and communicating well with them, other professionals, and people who use services.
At registered manager level, CQC found that strong leadership was characterised by individuals with an innovative, outward or forward looking approach who were open to feedback and actively sought out best practice to steer improvement. Successful attributes of good managers included being visible in the service and being known to staff, service users and their families alike.
Good managers truly valued their staff and supported them to maintain their knowledge of best practice and person-centred care through training and establishing ‘champions’ in different areas of care.
CQC identified that providers in successful services supported their managers to communicate a strong vision and values to all staff, encouraging a culture of openness and transparency.
Good and outstanding services were supported by quality assurance systems and processes to monitor standards, such as quality audits and surveys. In well-led organisations leaders would ensure these systems and processes were embedded across the organisation, with clear lines of accountability.
Culture: CQC found that particularly positive and supportive cultures were characterised by staff who were well-trained, caring, skilled, dedicated, enthusiastic and focused on positive outcomes for people.
Successful services were found to be open and transparent, with a culture of improvement based on good practice and feedback. Organisations with an identifiable link between organisational vision and values and quality were also more likely to be found to be ‘good’ or ‘outstanding’.
Conversely, services where there was little or no evidence of the organisation’s vision or values were more likely to be rated as ‘requires improvement’ or ‘inadequate’.
Practical examples provided by CQC of how a positive culture was created included:
• Staff not wearing uniforms in recognition that they were in people’s home and viewing themselves as ‘guests’.
• Involving people who use services in training.
• Staff designated as ‘champions’ in particular areas.
Person-centred care: The third key element that CQC found in high-quality services was a focus on person-centred care. CQC found that in high-quality services, staff really get to know people and understand their interests, likes and dislikes. CQC identified the following ways in which services achieved person centred care:
• Tailoring activities to individuals’ likes and interests, which often involved using the arts, such as music and singing, to find creative ways of enhancing people’s quality of life.
• Staff actively supporting links with the wider community and involving
volunteers in day-to-day activities.
• Arranging the environment so it provided positive living, learning and social experiences. For example, placing objects around the home that were meaningful to people and that they could interact with.
Characteristics identified by CQC as having led to poor quality care
CQC found that of the five key questions,‘safe’ had the poorest ratings, with 23% rated as requires improvement and 2% as inadequate.
Staffing: CQC found that staffing levels and training were key factors in providers being rated as ‘inadequate’ or ‘requires improvement’ for safety, specifically in terms of whether people’s needs were being responded to in a timely manner.
Medicines management: It is widely acknowledged that poor medicines management can have extremely serious consequences. CQC found that medicines management was a key factor associated with unsafe care.
Whilst CQC’s findings may merely confirm what people already know, it is worthwhile for care providers and staff to take time to consider the regulator’s analysis, which forms a useful guide for providers.
There can be no doubt that CQC will be focusing on the areas identified when they next come to inspect