Essential Standards & Implementation

Quality MonitoringFDAP Workshop

David FinneySocial Care Consultant

11 November 2010

1Aims of workshopThink about quality

Fit for purposeMeasurable changeContinual Improvement

Think about excellenceExceeding the markGoing the extra distance

2Focus of this workshopCare Quality Commission definitions

Overlap with NDTMS, Supporting People, TOPS & others

Examples from the CQC Provider Compliance Assessment document

Think about what we mean by outcomes and how this links with commissioners expectations3From Standards to Outcomes From ...You will have.....

three meals a day, including at least one cooked meal,....etc

To...You demonstrate that ...

people who use services are supported to have adequate nutrition and hydration 4From Standards to Outcomes (2)The home carries out a needs assessment covering:-Suitable accommodation & personal supportMeaningful education, training and/or occupationFamily/social contactProvision of disability equipmentMethod of communicationEtc

People who use services experience effective, safe and appropriate care, treatment & support that meets their needs and protects their rights5From Standards to Outcomes (3)From inputs to outcomes

From processes to experience of people in services

Generalised statements allows for flexibility

Example: Care is centred on them as an individual and considers all aspects of individual circumstances

Means you need to demonstrate that ........

6How to measure quality?Demonstrate that you have the evidence that outcomes are met

Say how the experience of people using services is improved through service delivery7Outcome Evidence (1)PrinciplesShow how individual needs are metThe views of people using servicesDescribe the experience people haveSay how equality, diversity & human rights are protectedShow how people are directly involved in decision making about:Planning their own careRunning of the establishmentDescribe how people are kept safe8Outcome evidence (2)Policies & procedures?

List is not enough not sufficient on their ownSay how put into practice to ensure needs are metImpact they have on outcomesHow help meet needsHow people are involved in their developmentHow they are reviewed

9Outcome evidence (3)Summary

Best evidence comes directly from clientsFocus on the experience of individuals

Demonstrates:Appropriate assessments and care planningHow risks are addressed and minimisedHow feedback has been listened toResults of any improvements

10Great sources of evidenceWritten comments from service users or carers

Notes of community meetings11Where do we find the CQC outcomes?

12CQC what they expect (1)Regulation 10

Registered person must:-

Regularly assess and monitor the quality of the services provided in the carrying on of the regulated activity....

13CQC what they expect (2)Regulation 10

The Registered person must send to the Commission, -when requested to do so:- -a written report - (quality monitoring)

-Together with any plans for improving the service

So Self Assessment is the key14Written Report?The Provider Compliance Assessment Report (PCA)

15Provider Compliance AssessmentCovers 16 Outcomes in 16 sections

Is a living document continually updated

Any outcome can be singly requested by CQC

Asks for evidence for each prompt

One for each location

16How do providers fill in the summary of evidence?Look at key principles in each outcomeAssess for complianceIdentify if an action plan is needed.17Lets look at an example!Outcome 1 Involvement & information

Note that there are some which apply specifically to Residential Substance Misuse Services 1L

Work through some of the prompts18Involvement & InformationOutcomes 1General principlesHow do you help people understand the options open to them to enable them to make an informed choiceBrochureRules and restrictions - explainedTreatment philosophyPre-assessment phase

Make sure people can have a say about how their individual needs are metAssessment conducted in cooperation with a clientIndividual needs & preferences are highlightedHow treatment programme meets their needsIncludes equality & diversity information

Involve people in the running of the serviceCommunity meetingsPolicy reviewPrivacy & dignity how maintained?19Personalised care & supportOutcomes 4, 5 & 6Make sure people have Personalised care planInvolvement in drawing up care planInvolved in reviewing care planHealth issues are well documentedHealthy living choices including nutrition - outlined

Cooperation with other providers/professionalsProtocols or agreements in placeDischarge arrangements are thorough (see 4N & 4O)

20Safeguarding & Safety Outcomes 8,9,10 & 11Safeguarding

Cleanliness & Infection control

Management of medicines

Premises & equipment.21SafeguardingPrinciplesTake action to identify and prevent abuseStaff and s/u understand aspects of abuse 7QGuidelines for staffRespond appropriately when abuse suspectedHave local safeguarding procedures available Have internal procedures regarding safeguardingUnderstand how diversity influences safeguardingProtect others from negative behaviourSpecific procedures regarding money 7M22PremisesOutcomes 10 & 11Regulations specify:-Suitable design & layout sharing & room sizes n/a !!SecurityMaintenance

Specific issuesSuitability you explainLegislation H&SAW, Fire, COSHH, DDA, Food, ElecDisposal of clinical wasteRisk assessment include self harm 10P - RSMSpace toilets, therapeutic activity, outdoor 10M23StaffOutcome 12 RequirementsRecruitment checks, qualified, legally in UK, registered with professional body.Employment practice job description, roles & responsibilitiesAgency need written confirmation of checks Expectations (which accord with excellence)CommunicationPromote independenceIdentify & respond to changing needsAware of company policies & procedures24StaffingOutcome 13Sufficient staffCompetenciesQualificationsSkillsBased on a needs analysis

Management structures that enable effective maintenance of staffing levels

Respond to changing circumstances leave, sickness, vacancies, emergencies 25Supporting StaffOutcome 14InductionSkills for Care 14ELearning & development (contributes to excellence)Based on needs of people using servicePlan which covers mandatory & sector requirementsRecord of staff attendanceResources made availableSupervisionOne to one or group so can be peer supportAt a time & frequency agreed with line manager26Quality & ManagementOutcome 16Relevant sources:-

Feedback from people who use servicesObservationsAuditsAdverse events, incidents, errors & near missesComments & complaintsInvestigations into misconductExpert bodies

What about your clinical governance arrangements?

27The CQC system (1)The Quality Risk Profile

28The CQC system (2)Wide range of sources of information

Stakeholders

Own surveys

Direct contact with service telephone or visit

Intelligence safeguarding, complaints, notifications

Provider Compliance Assessment29Excellence (1)SCIE have identified four key areas:

Control over significant life decisionsDay to day choices for the individual decision to participateHow a place is run community meetingsManagement listen to staff & service usersEvidence of changes as a result of listening

Positive relationships Partners/family/friends /community a processStaff treat with dignity match this with challenge!Focus on people as individuals personalise the programmeSensitivity to changes in peoples lives

30Excellence (2)Meaningful activities Finds out what people want to do emphasize agreement in participating in treatmentSeeks to develop independence emphasize goals of treatmentCommunity activities challenge to consider external

Organisation factors Quality assurance through review -learning organisationCommitment to excellent outcomes for service usersCommitment to staff development

Introduction in Spring 2011.

31The ongoing journeyHave you got an approach to the CQC Assessment?

What elements of excellence are you aiming for?

Is there crossover with NDTMS, TOPS & SP Quality framework?

Is there a better way?

32And finallyTraining Consultancy External review

Simplex solutions

Best of luck for the future

david@davidfinney.org.uk

www.davidfinney.org.uk33