Following Hallmark Care Homes first Outstanding CQC rating, Care, Quality, Governance and Compliance Director, Julie Rayner, shares Bucklesham Grange Care Home’s secrets of success and how the company supports the homes within its group to deliver high-quality care.
CHP: Can you tell us about your background and your current role at Hallmark?
JR: For over 12 years I have worked in regulation, initially for the National Care Standards Commission, the Health Care Commission and latterly for CQC as an inspector, area manager and a compliance manager. Within my current role, I support the group to improve care delivery, by implementing policies and undertaking regular internal audits so the homes are fully prepared ahead of CQC’s visit.
CHP: Tell us about your quality control systems and how they help you maintain good quality care?
JR: At Hallmark Care Homes we have a suite of clinical, environmental and health & safety audits that our care home teams complete on a regular basis. Our regional managers then have senior manager audits and we have linked their audits into the CQC domains, so our senior managers are auditing against CQC’s key lines of enquiry. I then do regular CQC style inspections at the homes, where I reflect what CQC would report on. Part of my internal compliance assessments include dining observation and I also complete a mini SOFI (Short Observational Framework for Inspection), which is an observational tool used by the CQC. This allows me to take time out and observe the interaction between the team and the residents and the quality of that interaction, leading into the CQC’s ‘Caring’ domain.
CHP: How does digital technology help you maintain good care quality? What technology do you use?
JR: We are currently implementing iCareHealth across the group, which is going to be a key part of our governance processes.
We have also launched an Electronic Medicine Administration Record (EMAR) system and this is extremely effective in monitoring the effectiveness of our medication processes. Both of these systems will improve the care delivery within our homes and allow us to have a far more robust grip on care planning, quality and clinical outcomes for people.
CHP: How do you address issues with care quality when they arise and prevent them from escalating?
JR: If an issue arises and I am doing my internal compliance assessment, I address it straightaway. I then write a full report for the general manager, which is then shared with the senior team. In that report, I give an overall quality rating, and a rating under each CQC domain. I identify if there are any breaches of regulations and I then give a number of recommendations which are then RAG rated under the project management traffic light rating system. The general managers take that information and construct a SMART action plan, which is a shared document so that as an Operations and Governance team, we can monitor both the content and delivery of that action plan.
CHP: What are your views on the current inspection regime? Do you see it as too burdensome or is it helpful?
JR: I think the current inspection regime can be over burdensome. CQC need to look at the time it takes to do an inspection and then provide the report in a timely fashion. An unacceptable delay in publication can have a huge impact on a business.
CHP: Does CQC set the bar too high in terms of achieving Outstanding?
JR: No. I think to achieve Outstanding the bar has got to be high! Where the difficulty comes, is that the Outstanding characteristics are not as clearly defined as the other ratings. Words like innovation and empowerment are used in determining outstanding characteristics, but for some providers it becomes difficult to interpret what CQC are looking for.
CHP: How does your complaints system work?
JR: Our complaints system is in alignment with the regulators expectations in terms of response timescales. Whenever feedback is received it is acknowledged straight away and then we appoint an appropriate person to investigate the feedback. We always provide the complainant with a full detailed response once the investigation has been completed. If the complainant is unhappy with the initial investigation then it will go to a second stage investigation by a team member senior to the initial investigator and if the complainant is still unsatisfied then we will signpost them to the Ombudsmen.
To support our complaints system, all of our general managers have an open door policy that empowers relatives to speak to them directly about issues before they escalate and all of our homes have quarterly resident and relative forums.
CHP: How do you help homes prepare for a CQC inspection?
JR: I go to the regional meetings where I feedback about how CQC inspect, what the inspector will be looking for, what a SOFI inspection is, and the kinds of things we need to be showing the inspectors. My inspections also prepare them ahead of CQC’s visit and if they have acted on my feedback following my audit in a timely manner then they should be well prepared.
CHP: What training do you provide to colleagues?
JR: I teach the general managers how to do SMART action planning, how to support the team during a CQC inspection, and the journey between delivering Good and Outstanding care. I also put together the Level 2 Mental Capacity Act and DoLS training and will be working with the Operations team and Learning and Development team to develop care planning training for iCareHealth and investigation training.
CHP: What were the extra factors that made Bucklesham Grange stand out from your other homes and become your first Outstanding?
JR: The residents are an integral part of the life and day to day running of the home. For example, they have a resident on their health and safety committee, they have residents who support the maintenance man to do work around the home and they have residents who help with recruitment. The team members are also extremely proud of what they do, so when CQC came in they were falling over themselves to tell the inspector all about their wonderful initiatives.
CHP: How do you intend to share best practice at Bucklesham Grange with the rest of your homes?
JR: The home team has already shared its experience with our general managers. I am continually sharing the points from the report with the team, and the CQC report and my internal audit has also been shared throughout the company.
Five ways to improve your CQC rating
- CQC don’t keep anything secret! Their guidance support on their website tells you exactly what they are looking for in their key lines of enquiry.
- Remove the mystique of CQC inspections. Coach your managers and teams about CQC, so that they feel empowered to tell the inspectors all the great things you are doing.
- Have good governance systems so you can identify where you need to improve before CQC does and look at how technology can improve your governance processes.
- Make sure you can evidence to the CQC that you are learning lessons.
- Make sure you have good, open and transparent feedback processes.