driving up quality - accord · staff receive training in providing person-centred support and this...

Driving Up Quality Self-assessment review 2017-2018

Driving Up Quality

The aim of the Driving Up Quality Code is to avoid what happened at Winterbourne View ever happening again. The specific aims of the code are to:

l Drive up quality in services for people with learning disabilities that goes beyond minimum standards

l Create and build a passion in the learning disability sector to provide high quality, values-led services

l Provide a clear message to the sector and the wider population about what is and what is not acceptable practice

l Promote a culture of openness and honesty in organisationsl Promote the celebration and sharing of the good work that is already out there.

The Code has a particular focus on people with challenging behaviour who have long-standing and complex support needs but can be applied to all people with learning disabilities, including those who have autism. The Code has been developed by the Driving Up Quality Alliance: Housing & Support Alliance, English Community Care Association, Voluntary Organisations Disability Group, Sitra, Association for Real Change, National Care Association, National Care Forum, Adults with Learning Disability Services Forum, Shared Lives Plus and the Independent Healthcare Advisory Services. There are five key standards in the Code.

Our commitmentAccord is committed to driving up quality in services for people with learning disabilities. As such, we are signed up to the Driving Up Quality code as part of our commitment to evidencing high quality values-led services that go beyond minimum standards and offer real choice and control.

We aim to keep it live and meaningful to encourage transparency, welcome challenge and reflective practice and protect people from the dangers and indignities of poor support. This is why we have a Champions Group who meet regularly and who organise events to celebrate our good work, as well as move on with initiatives within services.

Driving Up Quality: Initial Self-assessment accordgroup.org.uk/care

We have, since April 2017, employed a Service Enhancement Manager to the Quality Team. This manager looks at moving services forward positively. There is a focus on Positive Behavioural Support, advice and training in reduction and management of behaviours that challenge, “Good to Outstanding” initiatives, the use of technology as well as intensive training and support to services in need of extra or specialist support.

Our initial self-assessmentWe developed an initial self-assessment as a consultation document. This initial assessment was based on findings from our service review programme, customer feedback and other quality information.

Throughout autumn 2016 we consulted widely on the initial self-assessment, using the results to inform our overall self-assessment and associated Driving Up Quality Action Plan. In June 2017 Our Service Enhancement Manager also completed a full audit of the services in line with the Driving up Quality code and highlighted the following recommendations:

• Complete a full review of our approach to managing behaviours that challenge.

• Have a more cohesive and consistent approach to involving customers in recruitment and look into befriending or volunteer services for customers.

• Learn how to celebrate POP outcomes locally within service.

• Explore more customer focussed ways to get feedback

• Look into local colleges and perhaps partnerships with these that are mutually beneficial.

• Remove all unnecessary posters from walls within the homes ensuring environments reflect customer’s own home and not a ‘corporate’ environment

• Develop a range of customer engagement opportunities, including more formalised methods of influencing decision-making.

• Devise a system to match skillset of staff to customers.

• Review rota system in some homes to ensure full flexibility.

• Develop local files of local amenities, useful for both staff and customer.

• Review the scope of Residential and Supported Living within the services and ensure there is clarity between the two, and highlight expectation of service for each scheme and ensure management arrangements allow for sufficient support and leadership

These were put into individual action plans for each manager and to be taking into account by Accord as a whole.


Support is focussed on the person

What we do wellEach customer who is supported by the Accord Group has their own Personal Outcome Plan (POP) that it is intended to provide detailed guidance on the things that are important to them; their likes and dislikes and the outcomes that they want to achieve.

Plans are written in the first person and are intended to provide clear guidance to staff of how support is to be provided in a person-centred way that promotes independence, choice and control.

Service reviews and other quality assessments indicate that these plans are being completed to a high standard with detailed information about customer’s preferences and how they want support to be delivered to them.

They are integrated with a wide range of other person-centred documents including PEN pictures, Health Action Plans and Individual Management Strategies.

There is evidence that individual customer needs are identified and recorded so that the service they receive is directly tailored to these needs. Information is regularly reviewed and plans are updated as customer’s needs change or they express changing preferences.

A number of customers are assessed as lacking capacity; there is a proven track record of assessing capacity and, where a customer lacks capacity to make a decision, acting in their best interests based on the detailed knowledge that staff have of them. This also includes involving family, friends and other people important to the customer’s network of support.

We recognise that it is the customer’s home. All of our services are individually personalised in line with customer wishes. We reiterate that our staff are visitors in customer’s homes and maintain domestic-style living environments where customers can experience the same level of home comforts as anyone else.

We recruit staff based on ‘recruitment for attitude’ rather than their direct experience. What matters most to us is that staff actively demonstrates their commitment to the rights of people with a learning disability.

Staff receive training in providing person-centred support and this is reinforced through spots checks, supervisions and appraisals.


What we could do even betterWe could do more to widen our involvement and consultation mechanisms to ensure that the needs and experiences of customers with very complex needs also feed into reviews of the service in a more consistent way.

We are looking to add, as part of our Customer Involvement Strategy for 2017/2018;

• Customer Assessors

• Mystery Shoppers

• Formalised Customer Meetings

• Customer Involvement in Recruitment and selection of front line workers

We need to continue to improve opportunities for family and wider stake holder feedback, such as our ongoing commitment to our annual surveys, service coffee mornings, POP reviews with family members and our Driving up Quality open day which took place in July 2017 and was a great success.

We could also look into how we can better match customers with staff (for example in terms of activity provision) to ensure customer outcomes are most appropriately met.

Support to have an ordinary life

What we do wellOur customers live in community-based domestic houses within local communities.

They are actively encouraged to live full and fulfilled lives through access to mainstream community provision. This includes accessing community leisure and recreational facilities and accessing primary health care.

The Person Centred Plan (POP) tracks what is important to a customer in order that they can be supported to lead the lifestyle that is important to them and access community facilities that they enjoy.

Our customers are supported to maintain the networks of their choice and have opportunities to meet new people and form new relationships.

Staff use both public transport and specially adapted vehicles to ensure they can support customers to access community provision. We also have normal vehicles too that are not adapted where these are more appropriate or our customers to live a normal life.

Our customers are subject to no segregation and are supported to participate and live as active members of local communities. We are committed to positive risk-taking.

Our Christmas celebrations for our Learning Disability services for the last 3 years have been at a venue where other companies have their works Christmas parties. This has encouraged other people to integrate with our customers who may not have met people with Learning Disabilities before and therefore promotes inclusion of all without making our celebrations for customers only.

Where we can, customers are supported to access education and learning opportunities and have opportunities for personal development and growth. At a lower level, this also includes opportunities to promote independence in daily living skills encouraging customers to have maximum involvement in the running of their homes.

We have started to focus our managers on “Good to Outstanding” which includes a monthly review of outstanding services on CQC website which is fed down to the staff teams via a spreadsheet highlighting good practise and whether we can implement these or similar in any of our services.

An in depth thematic review into our approach to managing behaviours has been


completed and we are introducing a new training program and updated policy in relation to this, with a strong focus on Positive Behavioural Support and a change in culture within the staff teams.

We are continuing to work with a research body called the ‘Who’s Challenging Who’ project. We continue to take learning from this work and use it as an opportunity to identify any service improvements.

What we could do even betterWe could show greater innovation in meeting customer’s needs by offering a wider range of activity options including exposing customers to new experiences and enhancing meaningful community access.

Increased flexibility in staffing deployment could also enhance opportunities for customers- being sure that rotas are designed around customer needs as opposed to being more rigid service-based approaches.

For some customers, greater opportunities for participation in learning and employment could be explored such as opportunities for Social Enterprise. In addition other opportunities to participate and contribute include being involved in audit processes or staff recruitment. There may be particular opportunities to work with customers at across Accord to support a peer audit programme.

We are now looking at furthering our commitment to bringing technology into our services and are currently piloting Virtual Reality and iPad style tablets within our care and support services.

Care and support focuses on people being happy and having a good quality of life

What we do wellOur staff are encouraged to have an outcome focus that always puts the customer at the centre.

This process begins with recruitment (we are committed to value based recruitment) and is reinforced through induction, staff management, training and organisational policies and procedures.

Creativity and innovation is encouraged and both internal and external staff award systems are used to recognise where staff have gone the extra mile to ensure that customer needs are met. A number of our staff have recently been shortlisted for national learning disability awards, this is the second year running we have been finalists. We were also finalists in local authority care awards for 2 of our staff teams.

Staff have embraced opportunities to develop new initiatives and have been particularly involved in leading improvements in the physical environment. Gardening and upcycling projects are examples of work that has engaged customers and encouraged them to be actively involved in making home improvements.

Policies and procedures provide an overarching structure to promote safety and well-being and set required service standards but are not intended to be unnecessarily restrictive. Positive risk taking is positively encouraged.

We have a learning culture that encourages openness and transparency. Even where things go wrong, they are used as an opportunity to learn and make any necessary changes.

We have clear complaints systems in place in addition to a whistle-blowing procedure.


What we could do even betterWe have revised our management structures to ensure they best support services and there is clear and visible management presence. We called this simplification and it brought our company together under one sole entity.

Generic job descriptions are in place for all care workers and more specific job descriptions could add value in learning disability services. There are also more opportunities to involve customers in recruitment and selection processes.

The training offer in learning disability services needs to be more fully-aligned with the customer profile and increased more consistent provision of autism awareness training would be of benefit. Our staff told us they would like more “out of the Box” training.

Vacancy levels may at times impact on the consistency of service provision for customers- as an organisation, we need to look at how we better manage this and how we can attract a wider pool of applicants.

We continue to develop our Champions within our Learning Disability workforce. This includes Driving Up Quality Champions. These champions are instrumental in devising and delivering the Driving Up Quality action plan; ensure that all environments are working to the Driving Up Quality objectives.

The Care Quality Commission (CQC), has recently published good practice guidance ‘Equally Outstanding: Equality and Human Rights good practice resource’ providing key case studies, research recommendations and examples of best practice to support service transformation.

Within Accord, we have directly fed this work into our ‘Good to Outstanding’ service enhancement programme with a Manager’s ‘Dragon’s Den’ type session encouraging dialogue and debate as to how further work in this area can help lift our services further.

Following this, we are looking to roll out One Page Profiles in some services for both staff and customers. One-page profiles are the foundation of personalisation, and can lead to positive change for people, whatever their age or circumstances. They provide an at-a-glance way of knowing what really matters to people.

A good culture is important

What we do wellWe have clear organisational mission, vision and values that are further reinforced by a clear service philosophy.

Our underpinning values are reinforced through recruitment, induction, supervision, and training and through clear policies and procedures that underpin the service standards that we expect.

We have robust quality systems in place that monitors that delivery of services is in line with organisational and regulatory standards and best meets outcomes for customers.

We are a learning organisation that is committed to learning from where we get things wrong and taking proactive action to prevent recurrence. We use learning logs to ensure that learning opportunities are actively used to improve performance.

We are committed to listening to staff and have a formalised Staff Voices representative forum.

We are committed to developing our staff. A number of our Learning Disability managers have completed (and others identified to participate) in the Accord Group leadership programme. We have also developed staff in house through positions i.e. support staff to senior and deputies to Registered Managers.

We share good practices and good news stories across services to learn from each other and to acknowledge the work being done in schemes.

The Driving up Quality Focus Group hold meetings where we discuss some of the barriers towards Customer and Family engagement within the services and decided that we should have a Family Engagement Day where we could invite customers at services, their families, commissioners and senior management.

The points specific to our event were:

• all levels throughout the organisation consider and involve people being supported and families

• the organisation can evidence how change has resulted from the voice of people being supported and their families at all levels

• staff feel respected and able to voice their thoughts and contribute to organisational development.


What we could do even betterWe need to better track that improvements identified through customer feedback, complaints and thematic reviews are consistently used to deliver improvements.

We also need to continue ways of enabling opportunities to increase the role of families in providing feedback and feeding into service improvements.

• leadership utilises the skills within the organisation and inspires those around them

• leaders encourage open and honest conversations about what is and is not working

• decision making is based on the principle of ‘how will this benefit those we support?

We wanted it to be free for people, however we needed to have fun stalls in place (such as Tombola, Guess the weight of the cake, Guess the name of the Teddy etc) so instead of asking for money we asked for ideas on improving our services, suggestions about continuous improvement, which were written down and distributed to the Focus Group to look at how we could move forward with engaging with peoples families and any ideas for the future of our services and how they can be involved.

We even had a “stocks” for Accord Management in case of any disagreements!

We had our IT Team demonstrating our new “Immersicare” Virtual Reality software which was enjoyed by all who used it and feedback gained from all people was positive.

The event was a great success as it brought together customers, families and senior management from services across the West Midlands, from Birmingham, Wolverhampton all the way across to Telford in Shropshire.

The Focus Group received a lot of ideas and feedback on how we engage with customers and their families which will be fed into the Resident and Customer Engagement strategy for the organisation, to enable us to shape future working and policies around the feedback from our customers and their carers/families.

As well as the above we also hold coffee mornings in some services for family feedback and engagement.

Staff Voices systems are in place, there are ongoing opportunities for staff to provide feedback and actively contribute to driving forward issues at local service level.

Our main staff voices representative sits on the “Head of Service” meetings to feedback to managers and deputies. The Representative also goes around the schemes to gain feedback from staff in team meetings and via email.


operation in order that they can fulfil their governance obligation.

The Committee members have been briefed on the Driving up Quality standard and are involved in overseeing the work in this area.

What we could do even betterOur Committee members need to be continuingly assured that they are effectively scrutinising care and support performance information and making further enquiries where there are concerns or red flags.

A nominated member of the Group Board now sits on the Accord Group Safeguarding Scrutiny panel since October 2016. This has strengthened the governance around safeguarding and ensured greater links with the Accord Board.

Managers and the Board lead the organisation well

What we do well Our Managers are exemplars of good practice in learning disability services and all set high standards for their staff teams. They regular participate in local networks and are committed to ensuring best practice.

A number of services are actively participating in the ‘Who’s Challenging Who’ research project and we are committed to promoting innovative practice.

All of our Managers reinforce Accord values and ensure expected standards of conduct that focuses on the customer experience.

Managers are open and transparent and share information about what is going well and areas for improvement. Managers are committed to learning from adverse incidents to promote recurrence.

Senior Managers have regular visits to services are actively seek feedback.

The Executive Director of Health, Social Care and Support also ensure that periodic visits are made to services and opportunities are taken to seek feedback from customers and staff. C&S Committee members and the Finance Director have completed visits to all of our services.

Thematic reviews are independently conducted by members of the Group Quality team. Following these reviews there are action plans for the managers and staff teams to work towards to ensure we are taking a positive approach to improving services.

Each month the Care and Support Senior Management Group review case study outcomes and choose the winner of that months “Making a Difference” award. This has been awarded both to the Driving up Quality Project Team and a number of Learning Disability Services in the last 6 months,.

Committee members receive key performance information on services. This includes indicators around safeguarding and duty of candour incidents.

Committee members receive safeguarding training and are all subject to fit and proper person checks. They are appropriately briefed on the care and support


Driving Up Quality: Initial Self-assessment

driving up quality - accord · staff receive training in providing person-centred support and this...

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