21 December 2017

Ensuring we deliver quality care – The role of the Care Quality, Governance and Compliance Director

We know that in Hallmark care homes we provide care in beautiful environments which support residents to live as fulfilled life as they want and with access to well-maintained and functional outside areas. However, how do we demonstrate to prospective residents and their relatives, commissioners (i.e. those who purchase our services), members of the multi-disciplinary team (i.e. GPs, district nurses, dieticians, etc.) and our regulators that we are providing excellent or ‘Outstanding’ care?

This is where my role comes in. As an ex-CQC (Care Quality Commission) compliance manager, I have a rich background of regulation, identifying both good and poor care practices and providing service providers with feedback that will drive forward quality improvements.

In my opinion, the first step to providing a quality service is understanding what a quality service looks like. At Hallmark, we do this by providing General Managers with a full suite of clinical and organisational policies and procedures which clearly define how care and support is to be delivered. These policies and procedures are disseminated to the home teams, and we assess compliance with the content of these policies and procedures via a number of regular audits and assessments.

While it may be felt that audit is a ‘paper exercise’, audits have a key role to play in driving forward improvements and therefore ensuring that residents are receiving the quality care they deserve. We have a number of audits that are undertaken on a regular basis in all our homes; these audits measure the quality of our service provision in areas as diverse as care planning and infection control to maintenance and the quality of our hospitality services.

In addition to the audit schedule, as the Care Quality, Governance and Compliance Director, I undertake at least one full ‘internal compliance assessment’ every year at every one of our homes. These assessments allow me to undertake a full review of the service being provided in each of our homes and identify areas where improvements can be made. To make the outcome of these assessments clear, I award each home a ‘quality rating’ of one of the following:

• Inadequate
• Requires Improvement
• Good
• Outstanding

While some of you may recognise these ratings as the CQC ratings, I apply a higher benchmark than CQC do and apply the same quality rating across both England and Wales. This means that it is harder for one of our homes to achieve a ‘Good’ rating from me than it is from CQC!

I find it useful to apply such quality ratings and have such a high-quality benchmark as this really does drive forward improvements and ensures that our homes are not only meeting but also exceeding the expectations of our regulators, commissioners and members of the multi-disciplinary team.

While people are becoming increasingly focused on the outcome of the regulators’ visits, the experience of care provided to their relative is also (rightly) a very important quality indicator for them and, as such, our quality assurance processes need to ensure that this area of provision is appropriately assessed and evidenced. At Hallmark, we do this by applying a number of observational assessment tools such as:

• Dining experience observation tool
• Involvement and dignity observational tool
• Dementia Care Mapping tool
• Lifestyle and activity audit

Outcomes from all these assessments are fed back to the home’s General Manager, who can then, if indicated, make the necessary improvements.

To ensure that the outcome of all these audits, observations and assessments is actually impacting upon and driving forward quality, we expect each home to have an ‘improvement action plan’ in place. This is where the General Manager is expected to clearly capture how they are going to address any problem areas and secure ‘sustainable improvements’. Making a quick improvement is easy; making long-term sustainable improvements is more difficult and requires a clear logical approach to identify what the actual issue is (i.e. getting to the root cause), identifying what the eventual outcome is (i.e. what the best practice/quality standard is you want to reach) and then planning each step that will be taken to achieve the identified quality outcome. The importance of robust and effective action planning should never be underestimated in driving forward the quality of the care being provided in a care service.

Obviously, the outcomes we are wanting to achieve are positive feedback and thanks from residents and their relatives, and compliance or a ‘Good’ or ‘Outstanding’ rating from our regulators. It is really pleasing therefore to see the number of letters and cards our homes receive from grateful residents and relatives and the increasing number of our homes who are receiving ‘Good’ quality outcomes from CQC and ‘fully compliant’ outcomes from CSSIW (Care and Social Services Inspectorate Wales). This shows me that we are taking positive steps to achieve our 2020 vision of being “Recognised as the leading provider of high-quality relationship-centred care for all residents” and achieving those coveted ‘Outstanding’ reports. I know that our homes will continue to embrace best practice and will strive to continually improve for the benefit of residents and their relatives.

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