Posted: 23 September 2016
As part of my on-going quest to do what I exhort others to, that is continuously improve what our organisations provide, I had the privilege recently of accompanying a CQC inspector together with an Expert by Experience on an inspection visit. What I wanted to know was - what more can Skills for Care do to support the workforce to provide high quality, person centred care at all times.
We were a small team, Pete the Inspector, Graham the Expert by Experience (who wasn’t over keen on this title – he had been recruited because of his experience as the parent of a disabled young adult) and me. So; onto my impressions. Pete was very clear that he was unable to give any indication of the outcome ratings as there is a thorough moderation process within CQC once he has written his report which will include Graham’s analysis. It clearly would not be appropriate for me to give any comment on what my views were in this public blog so I will stick to the learning points for me and ultimately Skills for Care.
The welcome we received from Carol the Manager and Pat the Deputy Manager was warm and it was impressive that immediately Carol, who was relatively new in post, told us there were areas of practice she knew needed to be improved and that she had plans in place to do this. When Pete gave her feedback at the end of our long day, Carol was receptive and open to the points being made which was very encouraging that positive change will be made. There was a lot going on the day we arrived - people who lived there were busy getting ready to go out on a picnic, others had already left to go to various regular activity and to complicate things still further builders were on site as part of the service is being reconfigured.
What did I learn from this process? Too much to convey in a blog, so there will be more to follow.
Nine things struck me that I want to share here:
1) I was reminded of the importance of the Care Plan and that it is clear, accurate, up to date and person centred. Most important of all is that the staff providing care and support follow the Care Plan, which sounds like stating the obvious. The point that struck me is that with the range of support needs we saw, many of which were complex, putting together a plan that is easy to follow, contains all the information someone new coming in to work in a service will need to absorb quickly, is a real skill and one we need to pay more attention to. I also wonder what we can do collectively to reduce the amount of paperwork for busy people who want to spend most of their time with the people they support?
2) This leads on to the crucial importance of the recruitment process and whether values based recruitment is the bedrock, how involved the people using the service are in selecting new staff and how thorough the induction (including the standards in the Care Certificate) is.
3) And once the induction has been completed, what opportunities are there for on-going learning and development for the staff team? How many of them have been and are being supported to achieve their Diplomas at Level 2 and 3 and beyond? Is the training available to them relevant and appropriate to enabling them to provide continuously improving care for the people they support? I don’t think I’m straying too far from not commenting on the quality of what we saw if I share that I was very heartened to hear a support worker relay how the training in Mental Capacity Act had given them the confidence to advocate for a resident who did not wish to go into hospital, despite the paramedic being insistent that this needed to happen. It was also really positive to hear from another member of staff how the relationship they had built with the person they supported had led to a reduction in this person’s self-harming. What a joy to hear from each member of staff we had one to one discussions with that they do the job because they love it – and you could see this.
4) Medication administration is a key element of providing a safe service and any inspection so it is another key element of effective learning and development and also how systems work together. We all know the challenges when people come home from hospital with their medication not correctly provided or accounted for. It certainly made me think how can we improve the join up between different services to ensure people’s medication is managed safely and ensure all staff are confident and competent in the role they play?
5) What about the focus of the learning and development? Money is so scarce so how can organisations be confident of the quality and the relevance of the learning they buy for their staff? One way is Skills for Care’s Endorsement scheme so they can buy with confidence from quality assured providers.
6) The move from support worker to Team Leader and then to Manager is a clear career pathway available in our sector. The move from being supervised to supervisor is an important but sometimes tricky one but is there sufficient support available to help people make this significant step? The local Registered Manager networks supported by Skills for Care and the range of support we offer for managers is a vital part of supporting this crucial, yet for many, lonely role.
7) There were lots of other things we discussed including staff’s understanding of Safeguarding and Whistleblowing policies, how many complaints and compliments had been received, relationships with other professionals and agencies, how often supervision took place, what people learned from their annual appraisals, what relationships are like between support staff and the manager and the wider organisation, availability and relationships with advocacy services.
8) Ultimately what this experience reinforced for me is that effective adult social care is all about relationships. The relationships between the people who need care and support and the staff team and their organisation that provide this. Relationships within the staff team that need to be collegiate, supportive and able to constructively challenge (like all teams!) The relationships between professionals in different agencies (including the regulator and organisations like Skills for Care) who need to work together always focused on the individual who needs care and support. Plus the relationships between managers and relatives which needs to be sensitively managed on top of everything else.
9) A major question I asked myself and I intend to ask my team is given the challenges faced by employers are we providing the right solutions to support employers in recruitment, retention, succession planning, induction, learning and development, leadership and management , choosing the right learning and development for staff? I intend to address these in questions in future blogs.
And of course the biggest test of all – if I or someone I loved needed care and support, would I be happy for this service to provide it? I know what I think – I am looking forward to reading Pete and Graham’s report to see if we are in agreement.
So thank you to CQC, particularly Pete and Graham, for enabling me to go on this inspection and most importantly of all, thank you to all the people I met who either lived or worked in this service for your welcome and openness. I will take this insight and ensure Skills for Care practices what we promote about continuous improvement to ensure our support resources are even more relevant.
 All names have been changed to ensure confidentiality