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March 2016

your care rating2015 survey

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The contents of this report are of a commercially sensitive and confidential nature and intended solely for the review and consideration of the person or entity to which it is addressed. No other use is permitted and the addressee undertakes not to disclose all or part of this report to any third party (including but not limited, where applicable, pursuant to the Freedom of Information Act 2000) without the prior written consent of the Company Secretary of Ipsos MORI.

contents1 foreword 052 survey development 073 survey of residents 09

3.1 Methodology 093.2 The questionnaire 093.3 Survey response 093.4 Residents’ views of their care 13

4 survey of relatives and friends 254.1 Development of the survey 254.2 Methodology and survey response 264.3 Relatives’ and friends’ views of the care their loved one receives 27

5 summary 35

6 technical note 36Survey of residents 36Survey of relatives and friends 37Calculating the OPR score 37

foreword1

1 foreword

Douglas Quinn, Chairman Your Care Rating

I am delighted to introduce our annual report, which contains findings from the 2015 Your Care Rating Survey. Now in its fourth year, Your Care rating continues to help care homes and care provider organisations in driving service improvement, as well as giving care home residents a voice.

We are very pleased that 37 provider organisations chose to participate in the resident survey this year, covering more than 1,000 homes and almost 52,105 registered places. Furthermore, the response rate for the 2015 survey increased for the third successive year which is a testament to the high levels of resident engagement that our participating providers are achieving.

Results from the survey paint a positive picture with the overall OPR score increasing again this year. There was a 96% overall satisfaction score and 98% of residents agree that they are treated with kindness, dignity and respect. The survey results highlight some areas for improvement and care homes can use their detailed Your Care Rating reports to devise and implement quality improvement plans.

We are delighted with the success of the pilot relative survey undertaken in late 2015. 14 care providers took part and more than 8,000 responses were received, denoting an impressive 49.5% response rate. Once again, the results were broadly positive and underpin the resident survey outcomes. We hope to extend the scope of the relative survey in 2016.

Your Care Rating continues to be indebted to the Care Provider Reference Group (CPRG) whose members give up their time to discuss the directions of the survey and how these can be developed to assist care providers in their quest for continuous quality improvements. One suggestion that has been adopted is to create a link between the Your Care Rating results and the five CQC themes, and this is now being done in the detailed care home reports.

Once again, I would like to thank all of the residents and relatives who took part in the 2015 surveys and Ipsos MORI, whose continued support and expertise had helped us to make Your Care Rating the pre-eminent vehicle for structured and objective resident and relative feedback.

Your Care Rating: 2015 Survey 5

survey development2

As the largest sector survey of its kind, Your Care Rating offers care home residents the opportunity to give their views on the service they receive. The survey is conducted by the independent research organisation Ipsos MORI. It is also overseen by an independent Board of academics and representatives from the care sector, and a Care Provider Reference Group attended by members of providers participating in the survey.

Results of the survey of residents are published at the care home level each year on the Your Care Rating website: www.yourcarerating.org – further information about the survey can also be found on this website.

By providing a residents’ perspective through an accessible public source, the survey aims to:

• Give care home residents a voice;

• Allow participating providers to demonstrate their commitment to transparency;

• Drive quality improvements in the care sector, using benchmarking mechanisms and tracking of results year on year;

• Help shape the public image of care for the elderly by celebrating successes in the survey via national and local press;

• Provide an authoritative source of information to help customers choosing residential care services, as well as other stakeholders.

During each year of the survey, feedback and suggestions for its development are incorporated in the approach and design of subsequent survey waves. 2015 marked the fourth full year of the survey of residents and, following interest expressed by participating providers, the views of relatives and friends of those living in care homes were collected for the first time via a separate survey. This report presents highlights of the results from both surveys.

2 survey development


survey of residents 3

The Your Care Rating survey of residents is designed to be conducted in care homes primarily serving older people (aged 65 or over). The 2015 survey was conducted across 37 providers, totalling 1,040 care homes across the UK and 52,105 registered places.

3.1 Methodology

The survey uses a postal self-completion methodology and a standardised questionnaire. Each participating care home is issued a survey pack containing questionnaires for every registered place, along with instructions for administering the survey and pre-addressed freepost return envelopes.

Upon receiving survey packs, care home staff are asked to assess their residents’ capacity to provide informed consent to take part in the survey, only giving questionnaires to those able to consent. Relatives, friends and volunteers are invited to help residents take part in the survey but care home staff are instructed not to assist residents when completing the questionnaire itself. Tailored guidance documents are provided to each of these groups, explaining the survey process and how it should be correctly administered. Picture help cards are also available to assist residents with cognitive impairments.

Further information about the survey methodology – including the process by which results are validated – can be found on the Your Care Rating website1.

3.2 The questionnaire

The questionnaire was designed in 2012 with the close input of participating providers, and was cognitively tested with a sample of care home residents. It collects residents’ views across a range of aspects of life in their care home such as the capability and availability of staff, the quality and choice of food and being treated with kindness, dignity and respect.

In total there are twenty eight closed questions, and five open ended questions. The latter allows residents to make any further comments alongside their survey responses, which are shared with participating providers.

3.3 Survey response

In 2015, residents had ten weeks between August and October to complete their questionnaire and return it to Ipsos MORI. 20,520 questionnaires were returned, giving an unadjusted response rate2 of 39%. This shows year on year improvement – with a 36% response rate in 2014, and 35% in 2013 – reflecting Your Care Rating’s growth as the leading recognised survey in the sector. It also highlights the important role of participating providers in helping improve response rates, and their commitment to the survey more generally.

1 www.yourcarerating.org

2 The unadjusted response rate is calculated on the basis of the total number of responses, from the total number of registered places.

3 survey of residents

Number of care homes included in the 2015 Your Care Rating survey of residents

1,040

Unadjusted response rate – 20,520 questionnaires returned

39%


Figure 3.1 – 2015 Your Care Rating Survey map of participating care homes

Your Care Rating: 2015 Survey10

Figure 3.2 – 2015 Your Care Rating survey table of participating providers

3 Results for the Abbeyfield Society Assisted Living are not included in the calculation of benchmarks due to the different care setting provided

Care provider

No. of care homes

No. of registered places

Akari Care 39 1998

Anchor 85 4013

Avante Care and Support Ltd 12 733

Barchester Healthcare 198 12775

Borough Care Limited 10 431

Bury Council 2 150

Canterbury Care 9 334

Care UK 113 7152

Caspia Care 3 116

Chorus Care 1 60

CLS Care Services Limited 18 670

Cornwall Care 16 645

Countrywide Care Homes 33 1714

Embrace Group 77 2949

Forest Pines Care 3 245

Four Seasons Health Care 38 1812

Golden Manor Healthcare Ltd 1 62

Greensleeves Homes Trust 19 751

Hallmark Care Homes 17 1096

Helen McArdle Care 17 1089

High Trees Care 1 80

Jewish Care 10 643

Maria Mallaband Care Group 34 1517

Methodist Homes 87 4493

NorseCare 37 1393

Opal Care Homes 1 49

Royal Masonic Benevolent Institution 17 1091

Sheffcare Ltd 11 478

Sibbertoft Manor Nursing Home 1 41

Somerset Care Group 28 1407

Springhill Care Group Limited 3 253

Sussex Grange Ltd 1 20

Sussex Housing and Care 4 143

Tall Trees Care 2 46

The Abbeyfield Society 24 634

The Abbeyfield Society - Assisted Living3 59 684

The Brendoncare Foundation 9 338

Total 1040 52105


3.4 Residents’ views of their care

Your Care Rating collects residents’ views on a range of measures relating to the care they receive. Using respondent-level analysis of results, an ‘Overall Performance Rating’ (OPR) out of 1,000 is produced for each care home, along with four ‘theme’ scores.

The OPR takes into account responses to all questions in the survey and is calculated using statistical methods called factor analysis and regression analysis4. It is designed as a single score to allow objective and robust comparisons, both between care homes and over time. It is published with results for all measures in individual care home reports5. This section presents the overall aggregated results – including the OPR and theme scores – for all care homes6.

The average OPR in the 2015 survey is 878 out of 1,000 – a small increase when compared with the equivalent figure of 872 in 2014, and 871 in 2013 (see figure 3.3). Although there has been some change in the providers taking part in Your Care Rating between 2013 and 2015, overall, the results have therefore remained stable and consistent.

Figure 3.3 – Average OPR and theme scores

4 A full explanation of the OPR calculation process is provided in the technical note, and on the Your Care Rating website www.yourcarerating.org

5 Care home level results are published at www.yourcarerating.org

6 In line with results published at www.yourcarerating.org, results are based on analysis of data for 864 care homes where five or more responses were received and whose responses were included in the calculation of benchmark figures following validation. All overall results are presented as the average results achieved by these care homes (and not the average of all responses) - see the technical note for further information

Average Overall Performance Rating (OPR) score

878 out of 1,000

OVERALL PERFORMANCE RATING

8782015

8722014

8712013

Staff and Care

Home Comforts

Choice and Having a Say

Quality of Life

8772015

8712014

8522014

8542014

9222014

8572015

8622015

9262015

8692013

8522013

8522013

9232013

OPR


Figure 3.4 – Components of theme scores

The OPR score takes into account responses to all aspects of care rated in the survey. Factor analysis groups these aspects into four themes, within which the aspects are weighted in the OPR calculation according to their strength in driving residents’ overall satisfaction with the care home (regression analysis). Figure 3.4 shows the measures falling within each theme as grouped by the factor analysis, and figure 3.5 presents the result of the regression analysis, showing the relative influence of the four themes on residents’ overall satisfaction with the care home.

The Staff and Care theme has around twice as much influence on overall satisfaction as the other three themes, meaning residents giving a positive rating of any aspect within this theme are more likely to be satisfied overall, than when giving a positive rating of aspects in other themes.

The capability and availability of staff, and the time they have to talk to residents; staff treating residents individually with kindness, dignity, respect and sensitivity; access to medical professionals and follow up on concerns and complaints.

Residents having a real say in their care; access to the care home manager/senior managers; choice about time to go to bed and get up; easy access to a garden or outdoor space.

The quality and choice of food; quality of the laundry service; cleanliness and tidiness of the care home.

Residents having visitors when they wish; having their possessions around them; taking part in hobbies and activities; respecting residents’ privacy and feeling safe and secure.

Staff and Care:

Home Comforts:

Quality of Life:

Choice and Having a Say:


This regression analysis provides important context to the theme scores shown in figure 3.3. While the Staff and Care score has improved overall (moving from 869 in 2013 to 877 in 2015), aspects falling within Quality of Life achieved the highest theme score in 2015 (926). And while theme scores for Home Comforts and Choice and Having a Say are lower (857 and 862 respectively), the aspects within these themes also have a smaller influence on overall satisfaction. The relative pattern of theme scores is consistent with 2014 and 2013 results: aspects falling in the Quality of Life theme yield the highest of the four theme scores, while ratings relating to Home Comforts and Choice and Having a Say produce the lowest theme scores. In practice, the results for all themes are important in driving quality improvement and it is notable that all four theme scores were higher at the overall aggregate level in 2015 than in 2014.

Figure 3.5 – Regression analysis (four theme scores against overall satisfaction)

Your Care Rating has been designed so that individual care homes from providers which have participated in the survey year on year can track movement in their OPR. They can then use theme scores and ratings of individual aspects of care to diagnose potential areas for improvement.

Of the 864 care homes whose results were eligible for publication in 20157, 624 took part in 2014 and had their results published too. An analysis of movement in OPR scores for these care homes (figure 3.6) shows the proportion whose OPR has improved (50%) is similar to the proportion whose OPR has decreased (49%). This reflects the continuing challenges faced in the sector, but is also an opportunity to celebrate success, particularly for the 20% of these care homes for which OPR scores have increased by more than 50 points.

7 Care homes whose results are eligible for publication are those from which five or more responses were received, and whose responses were included in the calculation of benchmark figures following validation

Overall satisfaction with standard of care home

42% of total variation in the results is explained by the model

17% Staff

and Care

8% Choice and

Having a Say

8% Home

Comforts

9% Quality of Life


Figure 3.6 – Proportion of care homes seeing a change in OPR score since 2014

A similar pattern of change in OPR scores was seen between 2013 and 2014: 51% of care homes whose results were published had improved OPR scores, 1% saw no change and 48% saw their score fall. However, the gap between the highest OPR in 2015 (999) and the lowest (675) has narrowed. In 2015 this range is 324, compared with 364 in 2014 and 406 in 2013.

Regionally, care homes in the North East received higher OPR scores on average than care homes in other parts of the UK (figure 3.7), and the same pattern was seen in 20148. The average OPR score for the North East has also increased for care homes taking part in 2014 and 2015, from 886 (2014) to 893 (2015).

Some geographical differences also emerge when the range of average OPR scores is analysed by region. Participating care homes in Wales see a range of 179 points between the highest and lowest care home OPRs, while the range is wider in London, at 296 points.

8 It should be noted that regional analysis is restricted to care homes participating in Your Care Rating, and therefore does not provide a complete picture of care home performance by region

Increase of more than 50 points

%

Increase of between 1 and 50 points

No change

Decrease of between 1 and 50 points

Decrease of more than 50 points

31

1

-32

-17

20


Figure 3.7 – OPR scores by UK region

Overall views

While the care home OPR serves as a granular, comparable measure of performance as rated by residents, the survey also collects residents’ overall ‘top of mind’ views about life in their care home using three questions, shown in figure 3.8.

Happiness living in the care home

Over nine in ten residents agree that they are happy living in the care home, and this measure has received consistently high scores in the survey (92% in 2014 and 91% in 2013). Of those responding positively, 57% strongly agree with the statement – an increase from the 55% who said this in 2014.

Likelihood to recommend

Residents are also asked how likely they would be to recommend their care home if somebody they knew needed similar care to them. This question produces a ‘Net Promoter Score’9.

9 As with the Friends and Family test – used to determine whether service users would recommend services they have used – this question is designed to produce a Net Promoter Score (NPS). The NPS is calculated as the percentage of respondents likely to recommend their care home as 9 or 10 out of 10, minus the percentage rating their likelihood to recommend their care home as 0 to 6 out of 10

879 North West

885 West Midlands

890 Wales

869 South West

893 North East

870 East Midlands

875 Eastern

872 London

892 Yorkshire & Humber

875 Scotland

871 South East

Range shows the difference between the highest and lowest care home OPRs in each region. Results not shown for Northern Ireland as too few homes took part in the survey for analysis at this level.

284

269

286

272

280

249

179

257

296

248

269

Key: Range in points


“I am very happy living here. I like my friends, the staff team and the meals, and I’m never bored

“I feel like part of a family, living here

The average NPS in 2015 is +47, with the highest care home score achieving +100, and the lowest -100. In 2014 the average NPS was +44, and this figure was +45 in 2013, reflecting stability in this measure over time.

Overall satisfaction with the care home

Ninety six per cent of residents say they are satisfied with the overall standard of their care home, which represents no significant change compared with the 95% who said this in the 2014 and 2013 surveys.

Figure 3.8 – Overall measures

% agree happy living here

Net promoter score

% satisfied overall

92%

+47

96%

92%2015

92%2014

+472015

+442014

96%2015

95%2014

0

-100 0

0

100

100

100

91%2013

+452013

95%2013

40%

-100

43%

92%

+47

96%

100

100

100

Key: YCR low

Average

YCR high


“Staff go above and beyond their duty to help me – they know me personally and work hard

“Staff are not always around to help me as they are busy with other customers

“Not all staff understand my difficulties but those who do are very supportive

“Interactions with staff are pleasant, but very brief

Staff and Care

The Staff and Care theme is shown to be more strongly linked to residents’ overall satisfaction with their care home than any other of the themes (figure 3.5). As in 2014, residents’ ratings of staff and care generate the second highest theme score, of 877 out of 1,000 (figure 3.3).

Residents are asked to give their views on nine aspects of Staff and Care – the results across the full response scale are shown in figure 3.9 with the aggregate ‘agree’ and ‘disagree’ figures from 2014 and 2013.

Figure 3.9 – Staff and Care theme individual aspect scores

The staff treat me with kindness, dignity

and respect

n % Strongly agree n % Tend to agree n % Neither n % Tend to disagree n % Strongly disagree

I am happy with the care and support I receive

The staff here are capable of providing the care I need

Staff understand me as an individual

I am happy with the access I get to doctors,

nurses, dentists

Staff are sensitive to how I am feeling

Staff are usually available when I need them

I am happy with the way staff deal with any

complaints or concerns

Staff have time to talk to me

Agree Disagree

Agree Disagree

Agree Disagree

2015 2014 2013

98% 1%

97% 1%

97% 1%

96% 1%

96% 2%

95% 2%

92% 3%

92% 3%

92% 3%

96% 1%

96% 2%

95% 2%

91% 3%

91% 3%

90% 3%

89% 3%

89% 3%

88% 3%

95% 2%

94% 2%

94% 2%

90% 5%

89% 5%

89% 5%

85% 8%

86% 8%

85% 8%

74 24

70 26

64 28

68 28

55 36

33

64 30

54 36

56

3946


“The staff always ask me what time I’d like to get up and respect my wishes

“If I have problems then I know where the manager’s office is and they are always very helpful

As in previous years of the survey, residents are more likely to say staff treat them with kindness, dignity and respect, than they are to agree with any other of the statements within this theme. Ninety eight per cent of residents say this and three quarters of residents (74%) ‘strongly agree’ with the statement. This is an increase from the equivalent figure of 72% in 2014 – views on the way residents are treated by staff are therefore not only very positive, but this strength of sentiment is increasing.

This pattern of increasing strength of positive sentiment is also seen for several other aspects of Staff and Care. The proportion of residents who agree they are treated as an individual by staff, for example, has increased by one percentage point to 95% in 2015. Among these residents, 64% strongly agreed with the statement, up from 62% in 2014.

While on balance, ratings of all aspects of Staff and Care are very positive, there is some variation within this theme. As in previous years of the survey, residents are least likely to think staff have time to talk to them: 85% say this, but only 46% ‘strongly agree’ with the statement – the lowest ‘strongly agree’ score in the survey.

Staff availability and ability to deal with complaints and concerns also receive lower ratings on average. Since all aspects within this theme are highly correlated and more strongly linked to overall satisfaction than the other themes, addressing a perception of resourcing challenges in care homes may be important to help shape greater resident satisfaction overall.


Aspects relating to Choice and Having a Say include choosing when to get up, being able to speak to senior members of staff, and residents feeling they have a real say in how staff provide care and support to them.

The proportion who ‘strongly agree’ has increased for all statements falling within this theme, driving an increase in the overall theme score for Choice and Having a Say from 854 in 2014, to 862 in 2015.

Nine in ten residents (91%) say they are able to choose when they get up and go to bed (90% in 2014), and 64% ‘strongly agree’ with this statement (62% in 2014).

In comparison to the confidence with which residents give positive ratings of other aspects of their care though (with much higher proportions who ‘strongly agree’ than ‘tend to agree’), residents are less sure that they have a real say in how staff provide care and support to them. Eighty four per cent rate this aspect positively, and 11% responded neutrally saying they ‘neither agree nor disagree’.


Figure 3.10 – Choice and Having a Say theme individual aspect scores

Home Comforts

At the aggregate ‘agree’ level, residents’ ratings of material aspects of the care home such as food and laundry have remained stable across the 2013, 2014 and 2015 surveys (figure 3.11). For residents’ ratings of cleanliness, the laundry service and menu choices though, the proportion who ‘strongly agree’ with the statements has risen, neutralised by a slight fall in the proportion saying ‘tend to agree’. Again, this indicates that for those residents who feel positively about certain aspects of their care, in some measures this positive sentiment is even stronger than in 2014.

Residents rate the cleanliness and tidiness of the home, for example very highly (97% ‘agree’) and among these, 71% say they ‘strongly agree’ their care home is clean and tidy. This is an improvement of three percentage points since the 2014 survey, when this figure was 68%. Meanwhile the proportion who ‘tend to agree’ fell from 29% to 26% over the same period.

Residents’ ratings of catering in their care homes see lower ‘strongly agree’ responses by comparison, perhaps reflecting the challenges of providing meals to suit varying tastes and preferences. 56% of residents strongly agree the food served is good quality, and 52% feel strongly that the menu offers them a good choice of food each day.

I can speak to senior members of staff if I need

to (e.g. the manager)


I can choose what time I get up and go to bed

I have easy access to a pleasant garden/

outdoor area

I have a real say in how staff provide care and

support to me

Agree Disagree

2013

91% 3%

90% 4%

89% 5%

Agree Disagree

Agree Disagree

2015 2014

91% 3%

91% 3%

91% 4%

90% 4%

90% 4%

90% 4%

84% 5%

83% 5%

83% 5%

64 27

64 27

64 27

50 34

“The only thing I complain about is that the meals are cold when I get them in my room

“The home always smells clean, and it’s tidy


Figure 3.11 – Home Comforts individual aspect scores

Quality of Life

Ratings of Quality of Life have consistently generated the highest of the four theme scores: 926 out of 1,000 in 2015, 922 in 2014 and 923 in 2013 (figure 3.3). Furthermore, all measures within this theme have seen positive sentiment strengthen, with increases since 2014 in those who ‘strongly agree’, coupled with decreases in those who ‘tend to agree’, for all aspects.

As in 2014, residents feel more strongly that they are able to have visitors when they want to than they do about any other aspect rated in the survey. Nearly all residents agree that this is the case (99%), 85% ‘strongly agree’ (an increase from 84% in 2014) and only 1% have no feelings either way.

Relative to the results for other measures, residents also feel very strongly, on average, that they have enough of their own things around them. Ninety eight per cent agree, with 81% who ‘strongly agree’.

Broadly speaking, residents’ ratings of attributes in this theme paint a positive picture, with a maximum of 2% of residents responding negatively to statements.

This home is clean and tidy


The food served at mealtimes is of good quality

The laundry service is good

The menu offers a good variety of choices each day

Agree Disagree

2013

97% 1%

89% 5%

88% 5%

Agree Disagree

Agree Disagree

2015 2014

97% 1%

97% 1%

89% 5%

89% 5%

89% 5%

89% 5%

87% 6%

86% 6%

87% 6%

71 26

56 33

58 32

52 34


“My room feels like home, I have my own key

“The handy man is always available to help make my room feel safe and hang photos up when asked

“Staff always knock on the door before entering

“The home has a happy atmosphere, with a great feel of freedom

Figure 3.12 – Quality of Life individual aspect scores

Overall, residents’ ratings of the care they receive remain strongly positive, and with some improvements in scores for individual measures. The largest increases in positive ‘agree’ responses are seen for staff treating residents with kindness, dignity and respect (moving from 97% in 2014, to 98%), staff understanding residents as individuals (94% in 2014, to 95%), choosing what time to get up and go to bed (90% in 2014, to 91%) and having a real say in how staff provide care and support to residents (83% in 2014, to 84%).

As in 2014, the highest ‘agree’ score is for residents having visitors when they wish to (99% said they agree in 2014 and 2015), while the highest ‘disagree’ score is given by residents for staff having time to talk to them (8% in both 2014 and 2015.

I can have visitors when I want to


I can have enough of my own things around me

(photos, ornaments etc.)

This home is a safe and secure place to live

My privacy is respected

I can take part in activities/hobbies if I want to

Agree Disagree

2013

99% 0%

97% 1%

97% 1%

Agree Disagree

Agree Disagree

2015 2014

99% 0%

99% 0%

98% 1%

97% 1%

97% 2%

97% 1%

95% 2%

95% 2%

95% 2%

93% 2%

93% 2%

93% 2%

85 14

81 17

72 24

66 29

66 26


4 survey of relatives and friends

4 survey of relatives and friends

Since the first residents’ survey was conducted in 2012, there has been a growing interest in expanding Your Care Rating to include the views of relatives and friends of residents living in participating homes. After a scoping phase in the first half of 2015 which settled on a combined postal and online approach, Ipsos MORI conducted a pilot survey with a group of 14 engaged providers at the end of the year.

This chapter explains in further detail how the survey design was agreed and implemented, and like chapter 3, draws on aggregated results from homes which participated in the pilot survey to present the views of the relatives and friends who took part.

4.1 Development of the survey

A long-term aim of Your Care Rating has always been to extend the survey beyond older residents in care homes. Many providers already conducted surveys of relatives, but doing so as part of Your Care Rating gives the benefit of triangulating responses for some care homes using a consistent method. In 2015, with the residents’ survey well-established and with a growing appetite to consult relatives and friends on their perceptions of the care their loved one receives, Ipsos MORI undertook a scoping phase to look in more detail at the feasibility of a survey.

As part of this process, there were a number of questions to address and considerations to make. How best to distribute the survey? Who should be included? Would it be possible to collate relatives and friends’ details consistently from different providers? What questions should be included in the survey?

A working group of interested providers was set up to work through these issues, as well as develop a questionnaire which would not only meet the needs of participating providers, but which would also allow linkage between this and the residents’ survey.

A four-page questionnaire was designed and agreed in collaboration with providers (both those who ultimately participated in the 2015 pilot and those who did not). The survey focuses primarily on relatives’ and friends’ views of the care their loved one receives (though does touch on their own relationship with the care home and perceptions of its provision to relatives and friends too). Where possible, attributes were included which allow for a direct comparison with results from the residents’ survey.

As a pilot survey, results are presented at the aggregate level only. Ultimately, the aim is for results to be published at the care home level once the survey is established (as they are for the residents’ survey).

Total number of relatives and friends invited to take part in the pilot survey

16,521

Number of providers who took part in Your Care Rating’s pilot survey of relatives and friends of care home residents

14


4.2 Methodology and survey response

Methodology

The survey was mixed method, offering the capability to participate via a postal questionnaire or online. Paper questionnaires were sent by post directly to the addresses of (individual) named relatives and friends, with an invitation to complete the survey online sent by email to those for whom an email address was also provided. This approach allowed direct control over the process and who took part in the survey.

Details of individual relatives were transferred from care providers. As part of the sampling process data were cleaned to remove duplicate records, records with insufficient postal addresses and records identified as individuals linked to residents in a professional capacity.

Where more than one relative was identified for a resident, in instances of multiple relatives living at the same address, only one relative was included in the survey. In the case of multiple relatives living at different postal addresses, all were included in the survey.

Response to the survey

A total of 16,521 relatives and friends from 422 care homes were invited to take part in the survey. The first mailout was on 18 November 2015, with a reminder mailout sent in early December to those who had not responded. The survey closed in late December 2015.

Ipsos MORI received a total of 8,184 responses, representing an overall response rate of 49.5%. The vast majority of responses were received by post, as shown in figure 4.1:

Figure 4.1 – Responses to the survey of relatives and friends

Response rate to the pilot survey

49.5%

OVERALL RESPONSE SUBMITTED

RESPONSE SUBMITTED ONLINE / POSTAL

49.5%

Key: Online

Postal

96%

4%


4.3 Relatives’ and friends’ views of the care their loved one receives

2015 marks the first year in which the Your Care Rating survey has assessed the views of relatives and friends of residents in participating care homes. Of particular interest in this pilot year was whether or not results followed the same patterns as those seen in the residents’ survey. As this chapter will show, relatives and friends are broadly very positive about the care and support their loved ones receive, with interesting similarities (and some differences).

Calculating the Overall Performance Rating (OPR) and theme scores

A key interest in developing the relatives’ survey was to have a second set of data with which to compare the perceptions of residents with the views of their relatives and friends, on certain aspects of care. As in the residents’ survey therefore, an Overall Performance Rating (OPR) and four theme scores have been generated both to provide a more granular measurement of satisfaction and to produce a broadly comparable overall satisfaction measure between the two surveys. A detailed explanation of how these scores are calculated has been provided in the technical note. However, there are one or two important differences to note between how we arrive at the scores for the respective surveys.

The residents’ survey has twenty five questions while the survey of relatives has thirty eight. Of these, twenty one questions ask for ratings of the same subject matter. The relatives’ survey questionnaire was therefore designed to include questions equivalent to those of the residents’ survey wherever possible, with additional non-comparable measures also deemed important to measure by participating providers. In order for results across both surveys to be compared, the statistical models used to produce the OPR and theme scores for the relatives’ survey therefore only include questions measuring the equivalent aspects of care in both surveys. That is to say, not all attributes measured in the relatives’ survey contribute to theme scores – the additional, non-comparable measures are analysed separately for robust comparisons to be made.

As with the residents’ survey, overall results are based on analysis of care home data where five or more responses were received, and are presented as the average results achieved by these care homes (and not the average of all responses) - see the technical note for further information. However, demographic analysis contained in the report has been produced at the respondent level (and includes all responses from the survey).

“Staff have been extremely helpful and have listened to any of our concerns. I would have no hesitation in recommending them


Results for the Overall Performance Rating (OPR) and theme scores

The pattern of satisfaction follows that in the residents’ survey although consistently lower scores: relatives and friends are most satisfied with attributes contained within the Quality of Life theme, while scores for Home Comforts (while nonetheless very positive) fare less well against other themes (figure 4.2).

Figure 4.2 – OPR and theme chart for relatives results

Overall measures of satisfaction

The relatives and friends’ survey included a series of questions which allowed participants to give their overall views as a way of summing up their experiences.

As figure 4.3 shows, relatives and friends’ satisfaction scores compare fairly well with those seen in the residents’ survey, painting a positive picture of satisfaction with their loved ones’ homes.

When asked about their satisfaction with the overall standard of the care home, 93% of relatives and friends said are satisfied, only a little lower than the 96% of residents who said the same thing. As figure 4.3 also shows, the Net Promoter Scores (NPS) for the two surveys are very close too, with an NPS of +44 among relatives and friends compared with +47 for residents10.

10 As in the residents’ survey, the NPS is calculated as the percentage of respondents likely to recommend their care home as 9 or 10 out of 10, minus the percentage rating their likelihood to recommend their care home as 0 to 6 out of 10

OVERALL PERFORMANCE RATING

833Relatives

878Residents

Staff and Care

Home Comforts


Quality of Life

812Relatives

804Relatives

840Relatives

894Relatives

877Residents

857Residents

862 Residents

926Residents

OPR


Figure 4.3 – Comparison of overall results

A more detailed examination of results shows that younger participants aged 54 and below are typically less satisfied than older participants aged 65+ (90% vs. 95%). Similarly, those who visit their relative or friend at least once a week are a little less satisfied overall than those who visit less frequently than that (92% vs. 95%).

Most of the relatives and friends who took part in the survey told us that they think the home is good at keeping them informed about matters relating to their relative or friend (88% overall). Again, younger relatives and friends are typically less positive than older ones (81% of those aged 54 or under rate this as good compared with 91% of those aged 65+). However, on this measure, those who visit more frequently are more likely to feel well-informed than those who visit less often.

The majority of relatives and friends (72%) feel that their home provides value for money, compared with 12% who disagree. Younger adults aged 54 and below (62%) and those whose relative or friend’s care is fully self-funded (64%) are less likely to agree, while adults aged 65+ (76%) and those receiving some form of LA funding (79%) are more likely to feel they receive value for money.

Net promoter score

% satisfied overall

+44

+44Relatives

93%Relatives

-100 0

0

100

100

+47Residents

96%Residents

+44

93%

+47

96%

Key: Relatives

Residents

“The home has been brilliant with my dad’s care and feel like an extended family


Staff and Care

As in the residents’ survey, individual question attributes have been grouped into themes. The Staff and Care theme has the most influence on overall satisfaction (see chapter 3), meaning that residents who are positive about these aspects are more likely to be satisfied with the home overall. Results for aspects within the Staff and Care theme are shown in figure 4.4:

Figure 4.4 – Staff and Care theme

I am made to feel welcome when I visit

n % Strongly agree n % Tend to agree n % Neither n % Tend to disagree n % Strongly disagree n % Don’t know

Staff treat residents with kindness, dignity and

respect

Staff have a professional manner

Staff respect my relative or friend’s personal belongings

Staff are capable of providing the care my

relative or friend needs

I am happy with the access my relative or friend gets to

doctors, nurses, dentists

Residents are well presented (e.g. personal

hygiene, hair, clothes etc)

Staff know my relative or friend’s needs and

preferences well

Agree Disagree

97% 1%

96% 1%

91% 4%

93% 2%

89% 4%

87% 5%

91% 3%

87% 6%

I am aware of the procedure for making a complaint /

raising concerns83% 5%

Staff encourage my relative or friend to lead as independent a life as they

are able to

82% 5%

I am happy with the way staff have dealt with any complaints or concerns I

have had

80% 9%

Staff have time to talk to my relative or friend

73% 14%

There are enough staff to meet the needs of residents

58% 27%

76 21

61 34

55 38

57 34

50 40

52 37

43

46 41

49 34

44

4239

3644

3934

3523

“To my mother it is like being back in her own flat. The staff have helped me through many problems and I can’t praise them enough

“I found all the staff to be very friendly and they always find the time to talk to me when visiting

“The staff do their very best at all times but they always seem to be short-staffed which means residents have to wait


Broadly speaking, relatives and friends are overwhelmingly positive about staff and the care they provide to residents, particularly in relation to the welcome they receive when visiting, staff treating residents with kindness, dignity and respect, and their professional manner.

The only exception is with regard to feelings about there being enough staff to meet residents’ needs. While the majority agree that there is, a significant minority (27%) disagree that this is so, the highest proportion for any attribute in the survey. The highest levels of disagreement in the residents’ survey are for the statement ‘staff have time to talk to me’ (8%); around one in seven (14%) relatives and friends disagree with this statement too, with those who visit most regularly (at least once a week) more likely to disagree than average (18%).


The Choice and Having a Say theme covers a number of aspects relating to decision-making (both on the part of residents and their relatives and friends), as well as choice with regard to some of the facilities in the home. Results for attributes in this theme are shown in figure 4.5:

Figure 4.5 – Choice and Having a Say theme

I can speak to senior members of staff if I wish to

(e.g. the manager)


If I am the person who has authorisation, I have the

opportunity to be involved in decisions about my relative

or friend’s careIf I am the person who has

authorisation, I feel that staff appreciate my input into my

relative or friend’s care

My relative or friend has easy access to a pleasant

garden / outdoor area

My relative or friend can choose what time they get

up and go to bed

The home offers a range of activities for my relative or friend that suit their needs

I am given opportunities to comment on the running of

the home

Special food needs are met (e.g. low fat, diabetic, low salt, Kosher, gluten free)

Agree Disagree

94% 3%66 29

93% 3%58 35

75% 6%39 36

88% 4%52 35

74% 13%35 39

61% 3%28

85% 8%50 35

66% 12%34 32

33

“The manager and staff are completely dedicated to their roles

“Very impressed with the Manager. She is very supportive and communicates well by phone and email

“A good, clean, well run home


Results suggest that relatives and friends are particularly positive about decision-making processes relating to their relative or friend, with access to senior management and opportunities for involvement in decisions about their care coming in for high praise.

In contrast, comparatively fewer agree that they are given opportunities to comment on the running of the home (66%). Those who visit their relative or friend at least once a week (69%) are more likely to agree with this statement than those visiting less often than once a month (55%).

Home Comforts

The Home Comforts theme relates exclusively to the tidiness and condition of the environment in the home, along with food (quality and variety) and the laundry service. As figure 4.6 shows, results are once more very positive.

Figure 4.6 – Home Comforts theme

Relatives and friends are most positive about the cleanliness of the home and its maintenance, with strongest positive sentiment on these measures (58% and 57% ‘strongly agree’, respectively). They are slightly less positive about the quality and variety of food, albeit more than four in five agree that the quality is good and that the menu offers a variety of choices each day.

Those who visit most regularly (at least once a week) are likely to have a more positive view of food in the home than those who visit less than once a month, both in terms of the quality (85% vs. 79%), the variety (83% vs. 71%) and for meeting dietary requirements (65% vs. 44%).

The home seems clean and tidy


The building and outdoor space is well maintained

The smell of the home is generally acceptable

The food served to my relative or friend at mealtimes

seems of good quality

The menu offers a good variety of choices each day

The overall laundry service seems good (e.g. collection, return, washing and ironing)

Agree Disagree

96% 2%58 38

94% 3%57 37

81% 6%43 38

88% 7%44 44

78% 13%35 43

85% 5%46 39

“I am not sure my relative is taking up the opportunities offered to her by the home as she does not get involved in many activities

“My relative’s sister is able to visit her every week and deal with her everyday needs


Around one in eight (13%) disagrees that the laundry service seems good, much higher than the five per cent of residents who say the same.

Quality of Life

The Quality of Life theme score is the highest of all four themes among relatives and friends as it is among residents. Results for aspects contained are thus very positive, as shown in figure 4.7.

Figure 4.7 – Quality of Life theme

Almost every single relative and friend agrees that they can visit when they want (100%, with 85% agreeing strongly here), in line with findings from the residents’ survey on the same attribute (99%). The story is the same for feeling that residents can have enough of their own things around them (98% in both surveys) and the home being a safe and secure place to live (97% in both surveys).

However, residents are significantly more likely than their relatives and friends to agree that they are encouraged to take part in activities or hobbies if they want to (93% vs. 75%). Those who visit regularly are not significantly more likely to agree (74%) despite seeing their relative or friend more often.

Overall, the two sets of results showing residents’ and relatives’ views provide insightful comparisons. Overall satisfaction among the two audiences is at similar levels, as are ratings of other comparable measures such as staff treating residents with kindness, dignity and respect. Meanwhile on some measures there is a gap between residents’ and relatives’ views, particularly for ratings of participation in activities, choosing when to get up and go to bed, staff having time to talk and satisfaction with the way complaints and concerns are dealt with.

I can visit my relative or friend when I want to


My relative or friend can have enough of their own

things around them (photos, ornaments etc)

The home seems a safe and secure place to live for

my relative or friend

My relative or friend’s privacy is respected

The home seems a happy place to live

My relative or friend is encouraged to take part in

hobbies of interest to them if they want to

Agree Disagree

100% 0%85 15

98% 1%71 27

91% 3%48 43

97% 2%64 34

75% 8%36 40

93% 2%61 32

“Laundry is to a high standard except my mother ends up with others’ towels even though everything is labelled

“I feel greater use should be made of volunteers, to extend the range of activities and stimulation for residents


summary 5

5 summary

Once again, results from the 2015 survey paint an overwhelmingly positive picture of resident satisfaction in participating care homes. The strong results from 2014 have broadly been maintained or improved, and the OPR score of 878 is the highest recorded in Your Care Rating since its inception. With relatives and friends also taking part for the first time this year, and with an equivalent OPR score of 833 among this audience, clearly residents and their relatives and friends are exceedingly positive about the care and the service they receive in their homes.

The findings from the two surveys show a number of similarities – a strong endorsement of the results from both audiences. In particular, both residents and their relatives and friends are very positive about choice and their involvement in decision-making processes, along with aspects relating to quality of life. Both audiences are also very positive about the role that staff play in their care and in treating them with kindness, dignity and respect.

However, once again, the results for aspects relating to staff and the time they have for residents provide a note of caution – in both surveys, agreement that staff have time to talk is among the lowest scoring attributes, and relatives and friends are far less likely to agree that there are enough staff to meet residents’ needs than on other measures (indeed many disagree that this is so). With further increases to the national minimum wage this year putting more strain on staffing levels, 2016 will be a vital year for providers in the care sector, and will make gauging residents’ and their relatives and friends’ views all the more important.

Analysis from 2015 shows that many homes which have taken part previously have seen an improvement in their results. For those homes which have not improved in 2015, the survey allows managers to prioritise areas most in need of their attention in order to drive service improvement. Data from relatives and friends will help to supplement this in future years to provide a more rounded picture of customer satisfaction. In the short to medium-term, it is hoped that an equivalent staff survey will be developed to complete the picture.

The 2016 survey will be the fifth full residents’ survey, and it is likely that results from the relatives and friends’ survey will be published for the first time. The sign-up window for both surveys is now open, with further information provided on the Your Care Rating website, which will be updated throughout the year11.

11 www.yourcarerating.org

March-July 2016: sign up period for the 2016 survey

2016


6 technical note

Your Care Rating is open to care homes in participating providers across the UK. Views of residents and of relatives and friends are collected annually via separate surveys. 2015 marked the fourth year of the residents’ survey, and the first year of the survey of residents and friends.

When interpreting results from Your Care Rating, it is important to note that all results are subject to sampling tolerances and therefore not all differences are statistically significant. The residents who took part in the surveys are, in the main, a sample of the total “population” of residents, so we cannot be certain that the figures obtained are exactly those that would have been reached if everyone had responded (the “true” values). Results for individual care homes are based on smaller base sizes and therefore differences in results may not be statistically significant.

OPR and theme scores are shown out of a possible total of 1,000. Percentage scores are shown out of 100%. Where figures do not add up to 100%, this is due to computer rounding. An asterisk indicates a score less than 0.5%, but greater than zero.

Survey of residents

Fieldwork was conducted between August and October 2015. A total of 20,520 residents took part in the survey across 1,040 care homes. Results are shown for all valid responses (excluding blank responses to questions). In 2014, 21,300 residents took part across 1,034 care homes and in 2013, 21,190 residents took part across 1,055 care homes.

Results presented in this report are based on analysis of data for individual care homes except where stated otherwise. Results of the residents’ survey are based on a total of 864 care homes in 2015 (932 in 2014 and 988 in 2013) where five or more responses were received and whose results were included in benchmark figures following validation. In addition, for each individual question any homes receiving fewer than five valid responses to that question are excluded from the calculation. All overall results are presented as the average result achieved by these care homes rather than the overall result of all respondents.


In order to maintain the rigour of the survey and address any issues arising during fieldwork, the survey incorporates an extensive validation stage which takes place during and after fieldwork. Validation involves monitoring fieldwork, including email and telephone follow-up with care homes to verify receipt of survey packs, and reminder communications throughout fieldwork. It also involves a review of response rates and results to identify patterns in the data which are unusual and may require further investigation. Lastly, Ipsos MORI’s trained telephone team conducted telephone interviews after fieldwork closed with the survey lead at 100 care homes (this equates to around 10% of participating homes). The selection of care homes for these interviews was based on a review of data and response rates as well as information collected during fieldwork. Care homes from all providers participating in the survey were included in validation interviews. Interview questions covered survey administration procedures such as assessment of informed consent and assistance provided to residents. The survey leads interviewed were also asked for their feedback to inform improvements to the survey process in subsequent years.

Twelve care homes from a total of 1,040 participating homes were excluded from benchmark calculations following the validation process.

Survey of relatives and friends

Fieldwork was conducted between November and December 2015. A total of 8,184 relatives and friends took part in the survey across 422 care homes. This comprised 7,846 postal responses and 338 online responses. Results are shown for all valid responses (excluding blank responses to questions).

Results presented in this report are based on analysis of data for individual care homes except where stated otherwise (demographic analysis in chapter four has been performed at the individual respondent level). Results are based on responses for a total of 404 care homes where five or more responses were received. In addition, for each individual question any homes receiving fewer than five valid responses to that question are excluded from the calculation. All overall results are presented as the average result achieved by these care homes rather than the overall result of all respondents.

Calculating the OPR score

OPR and theme scores are shown out of a possible total of 1,000. The OPR is calculated using factor analysis and regression analysis. It offers greater granularity and basis for comparison than would the measure of residents’ satisfaction with the overall standard of their care, which is expressed as a percentage. Consistent factor analysis and regression analysis models are applied to comparable attributes in both surveys.


First, the statements residents are asked to respond to in the survey (the ‘aspects’) are grouped into four themes of statistically related (correlated) aspects, derived from a statistical process known as factor analysis. Within a theme, each of its constituent statements is given a weight, chosen to maximise the independence of each theme from the other themes.

For each resident, a score out of 1,000 is calculated for each of the four themes. This ‘theme score’ is therefore determined by the ratings of the aspects within that theme, taking into account their different weighting (the heavier the weight of an aspect, the more it counts towards the theme score).

Each of the four theme scores is then given a weight using a statistical process called regression analysis. The weight is determined by the strength in which responses within that theme are related to residents’ overall satisfaction with the standard of their care home, as captured in the relevant survey question. The relative weights of the four themes for each individual resident are fed into the calculation of the OPR score, where a heavier weight reflects a closer relationship with overall satisfaction, and contributes more to the OPR score.

Residents’ individual OPR and theme scores are then averaged to produce the equivalent scores for each care home. The care home OPR score therefore reflects what residents think across a range of aspects, weighted by how important those aspects are in driving residents’ overall perception of the care home.

It is important to note at this point that the above statistical analysis is carried out on all valid responses, so if a participant has not rated an aspect then this will not impact the score for a theme or overall.


By taking part in the Your Care Rating survey, care providers are demonstrating very tangibly their commitment to:• Hearing the views of residents• Improving further the quality of their services

To recognise this, Your Care Rating will allow them to use the Quality Mark.

For further information visit www.yourcarerating.org

FOR MORE INFORMATION

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