Bhavna Keane-Rao, Managing Director, BKR Care Consultancy and Charlie Jones, Care and Clinical Director, BKR Care Consultancy
The CQC inspection went well, and your inspector indicated that they may be considering a rating of ‘Outstanding’. Then you receive an email inviting you to submit a document asking you to explain why you should be rated ‘Outstanding’, which, given CQC’s need for evidence-based inspecting, seems a little unusual. Eventually the day arrives when the draft report arrives in your email inbox, or on the doorstep, Outstanding emblazoned proudly on the front page.
The finalised report appears on the CQC’s website and there are the usual calls and messages of congratulations and perhaps some press interest. There may be an increased bed demand at the service as a result of the rating, however there are also down sides, for example the Registered Manager is suddenly a target for head-hunters. However, as one of our clients, Nina Sharpe Adult Care Director of SENAD Community, said, ‘Achieving an Outstanding Care grade cannot be reached by the Registered Manager alone. It has to be at the very core of the organisation and must filter down from Director level through to the support staff that work tirelessly to deliver it’. It is probably the active pursuance of this philosophy that has resulted in the services supported by Nina Sharpe achieving Outstanding ratings from the CQC.
Additional drawbacks may manifest in more day-to-day situations such as families referring to the rating when they are unhappy with some aspect of the service. It is our experience that relatives are quicker to raise their concerns directly with the regulator, rather than through the in house processes, where they feel the rating does not match their own experience of the service. In addition, staff often relax their efforts, less concerned at the continuing or furthering work that may be required as they see the service as at the pinnacle of its achievement.
It is not uncommon for whole organisations to become ensnared in the same trap, such as assigning the ‘Outstanding’ services manager to support other group services. This can, however, result in a key element in maintain the outstanding rating being absent for significant periods with a likely detrimental impact on compliance. Careful planning would be required to effectively cover the managers role in maintaining the standards at the service. There would also need to be clear lines of communication with service users and their relatives to ensure their continued support for any interim Manager who may be appointed.
There is no doubt that achieving an Outstanding rating is something the service, its manager and the company should be proud. However, care needs to be taken to ensure that the journey is not perceived as being complete, as Nina Sharpe observes: ‘Maintaining it requires there to be focus and commitment at all levels. The whole organisation needs to be reflective in their practice and committed to constantly building on their knowledge and successes’.
There are clear benefits to being awarded the highest possible rating from CQC. These may include higher levels of funding from Local Authorities or better borrowing or insurance terms. There is also the benefit that the service becomes a more attractive prospect to staff resulting in easier recruitment and better staff retention. The service is also likely to be more desirable for those seeking accommodation for their family members and thereby shortening the length of time rooms are unoccupied.
Though the break from the cycle of CQC inspection may also be welcomed by some services, caution should be exercised. It is our experience that ‘Outstanding’ rated services will generally depend on the knowledge that the CQC will not inspect for the next three years unless they receive a serious allegation or incident.
The attainment of an ‘Outstanding’ rating is often the driving force for staff and manager to keep driving forward the quality of the service being provided. It is really when the outstanding rating is achieved that the hard work begins, it is far easier to attain than to maintain excellence.