Whether you’re a care home manager waiting for your first Care Quality Commission (CQC) inspection or have several years of experience with the process, getting an outstanding CQC rating can feel like a tricky goal.
According to the CQC’s own report on the state of health care and adult social care in England in 2021/22, only 5% of adult social care services in the country received an overall outstanding rating.
So, how do you show the inspection team that your care home is outstanding? And if you’ve previously achieved a good rating and want to go for gold, how do you improve standards?
We’ll start this post with some essential information about the way CQC inspectors assess care homes. Then, we’ll give you practical tips on how to achieve an outstanding score at your next inspection.
Five key questions
CQC inspectors use five key questions to assess the care homes they visit:
- Is the service safe?
- Is the service effective?
- Is the service caring?
- Is the service responsive?
- Is the service well-led?
You’ll be evaluated in each of these five areas, which are known as key lines of enquiry, or KLOEs for short. To get an outstanding rating overall, you’ll need an outstanding score in at least two KLOEs.
The difference between good and outstanding
There’s nothing wrong with a good inspection rating. If your care home has been given a good score, that means you’re meeting all the standards set by the CQC. Your residents are probably well cared for and happy. In short, a good CQC rating is something to be proud of.
Outstanding care homes are truly exceptional. If you receive an outstanding score at inspection, it means you’ve gone above and beyond what’s expected of you.
According to CQC guidelines, outstanding care homes are:
- Safe, and devoted to excellent care. Staff protect residents from avoidable harm, and do all they can to provide high-quality continuous care.
- Effective in every way. Care, treatment and support plans have good outcomes and help residents maintain quality of life.
- Caring and compassionate. Team members treat residents with respect, dignity and empathy, and where possible, involve them in decisions about care.
- Responsive. Managers take the initiative to create and provide services that make a positive difference to residents’ lives.
- Well managed. Care home leadership teams stay closely involved, practise good governance, and promote both learning and development and an open, fair culture.
CQC KLOEs: what to remember
Let’s take a moment to break each CQC KLOE into actionable pieces you can focus on when assessing your care home before an inspection.
Is the service safe?
- Look at your safeguarding policies and procedures to make sure staff are well trained and know what you expect of them
- Review your risk management guidelines to lower the risk of incidents and near misses occuring.
- Recruit staff based on your values to make sure they have the right skills and attitudes to perform well in their roles.
- Make sure staffing levels are adequate and based on the needs of the residents you care for.
- Provide staff with regular medicines training to reduce mistakes.
- Deal with incidents thoroughly and promptly when they occur, and make sure everyone can learn from adverse events.
Is the service effective?
- Make sure you provide care and support in line with current legislation, evidence and standards, and let your team know if and when things change.
- Double check all qualifications and experience to make sure staff have the skills and knowledge they need to provide excellent care.
- Take retention seriously, and gather evidence to show you understand the link between low turnover and high-quality care, and that you value and support staff.
- Support staff, ask them for feedback, do performance reviews and help them develop their skills.
- Carry out regular safety checks, and keep all your equipment and buildings in good repair.
Is the service caring?
- Make kindness, compassion and support a central part of your team culture and the way you approach residents.
- Involve residents in decisions about care, and give them the information they need to know. Encourage staff to support each other and the people you care for.
- Show that you understand and embrace human rights, give residents privacy, dignity and independence, respect their beliefs and challenge discrimination.
Is the service responsive?
- Create detailed care plans that describe treatments and resident support needs clearly.
- Give residents as much independence as possible to help them reach their goals and improve quality of life.
- Provide person-centred care, where you work closely with residents to make sure they’re happy with the care they receive.
Is the service well-led?
- Maintain a positive culture at your care home, putting people at the heart of your business.
- Outline a strong vision and a solid set of values – and create strategy based on your team and the people living in your care home.
- Make sure senior staff have the knowledge, experience and integrity to run a care home to CQC standards.
- Put a robust governance framework in place that meets legal standards and helps keep staff and residents safe.
How to achieve an outstanding CQC rating
Ready to excel? Here are five steps you can take to increase your chances of an outstanding CQC rating.
1. Look for outstanding inspiration
You can find lots of information about CQC assessment, standards, procedures and guidelines for care home manager on the Care Quality Commission's website. But if you want to find out how to get an outstanding CQC rating, you might find other providers’ published reports especially helpful.
Members of the public can access CQC reports, so you can download the ones you want to read and review them easily. The site’s search function makes it simple to find similar providers or specialist services.
Reading inspection reports from care homes or service providers who’ve recently been rated outstanding is an excellent way to see:
- What stands out to inspectors.
- Habits your own service might be able to adopt.
While all care providers are unique, outstanding services have a few things in common, including:
- A culture of continuous improvement.
- Creative or innovative ways to care.
- Excellent leadership.
- Consistently going above and beyond to offer personalised support.
2. Assess yourself
If you’ve been inspected before, make sure you address any issues raised by the inspector and provide evidence of the steps you’ve taken to improve standards. It’s important to document everything, so before your next inspection, make sure all your paperwork is organised, detailed and easy to access.
Think about ways your service goes above and beyond to deliver care:
- What makes you unique?
- How can you demonstrate excellence?
- What do residents and family members think about your service?
You’ll also need to show the inspector that you have robust systems in place to deal with incidents, concerns and complaints from residents, staff or families. Showing small but obvious improvements based on feedback is a great way to prove your commitment to outstanding care.
If you don’t already have a feedback system, now’s the time to ask for input from staff, residents and loved ones. Many outstanding providers take regular surveys and create action plans based on what they find.
Finally, take a close look at the inside and outside of your care home:
- Are indoor spaces clean, comfortable and inviting?
- Does it feel like home?
- Could anything benefit from an update or a fresh coat of paint?
- Are outdoor spaces safe, accessible and tidy?
3. Focus on individuals
Get to know all your residents personally. The more you tailor care to their individual needs, wants and goals, the better.
These five questions can help you understand what your residents value most:
- What are their backgrounds?
- What are their goals?
- What’s challenging for them?
- What do they enjoy?
- What makes them feel safe?
Empower residents as much as possible by involving them when you create care plans. Make those plans detailed, and keep them updated when people’s needs change.
Don’t forget to ask how you can help residents live independent, dignified lives – and help them access other health and care services, employment or education.
Let individuals shape bits of your service, from meals to social activities. Wherever possible, find ways to help those in your care (and their loved ones) make positive memories.
Inspectors often mention meaningful, personalised care in the reports they write about outstanding providers. For example, in the outstanding CQC Inspection report on Valerie Manor, a care home in West Sussex, the inspector remembers how staff went the extra mile:
The registered manager told us about one person whose granddaughter was getting married. Two care staff accompanied the person to the wedding and even put a ribbon on the car, to make the journey feel extra special. One staff member even put on a chauffeur's hat when driving the car.
If you keep people at the centre of your efforts when preparing for your CQC inspection, you’re on the right track.
4. Support your staff
Healthcare staff often feel stretched to their limits, so make team wellbeing a priority. Making sure your care home offers the best possible working conditions for your employees can help you recruit and retain the very best care professionals.
Services rated outstanding by the CQC:
- Have an open, positive working environment.
- Involve staff in leadership decisions.
- Help team members achieve a better work-life balance.
- Offer long-term career opportunities
These four tactics all lead to higher retention rates. Long-term staff can build better and deeper relationships with the individuals in their care, improving both safety and continuity of care.
If you want to learn about practical ways to engage, manage and develop your care workforce, check out our free, on-demand webinar.
5. Embrace creativity & innovation
The care industry is constantly changing, and technology is your friend. Nearly all outstanding care homes deliver care creatively and use technology to improve services.
With that in mind, we recommend looking for new, tech-based ways to improve processes, complete paperwork, and boost communication.
- Keep documents like care plans and staff rotas accessible and up to date in the cloud.
- Help your staff learn about new technology and innovative ways to care.
- Take advantage of digital resources, from medical journals like the BMJ to Florence Academy e-learning packages.
Tapping into the ‘hive mind’ of your own facility is one of the best ways to create a culture of continuous improvement. Ask residents, staff and relatives to share new ideas to help shape your services for the better.
Taking care to the next level
An outstanding CQC rating could give your care home’s reputation a real boost and make your business more successful.
Remember, every step – no matter how small – will take you closer to your ultimate goal. With enough dedication, constant improvement and a commitment to putting residents at the heart of your efforts, you could really shine at your next inspection.
And we think you can do it. We’re on your side.
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