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Achieving an “outstanding” takes teamwork


manager_Lisa_with_service_users_George_James_Samuel_Mark

When faced with the day-to-day challenges of caring for people it can sometimes seem that the service levels needed to achieve an “outstanding” rating from the regulators are an impossible dream.

Regard has put in place its own rigorous audit procedures of services aimed to support them in achieving that “outstanding” rating.

At each of its 147 services the focus is on involving people in decision making about their own care. The in-house auditing system sets rigorous standards which are above those demanded by the Care Quality Commission or the Care and Social Services Inspectorate for Wales.

The recent achievement of a CQC ‘outstanding’ rating for Douglas House in Plymouth, which supports four adult service users with learning disabilities and mental health issues, was made possible through the staff at the service involving those in their care in decisions backed up by quality auditing. Like all of Regard’s services Douglas House puts service users at the heart of the community where they live.

The audit team began its work in 2007 and since then it has become an integral part of Regard’s growth and success as a high quality provider of care services. A bespoke ‘traffic light’ auditing system was introduced in 2014, which sets higher standards and is more rigorous than those required by the CQC, while matching the key lines of enquiry used by them.

Regard’s own auditors visit the localities and give practical feedback, helping those who are in the service day to day to better-address issues that they are sometimes too close to notice. The Quality Team then works with the in-house team to introduce changes.

For instance an audit at Ambleside, Surrey identified a recurring issue over flooring that needed to be adapted to the needs of particular service users. Changes were made improving the quality of life of those who live there.

At Beudygwyn in Wales actions to meet some points raised by local authorities had a negative impact on other areas within the service. A team approach has transformed the service with staff now feeling their work is more effective and that there has been an improvement in the atmosphere of the service.

Amy Jupp, Inspection Manager, Care Quality Commission, East Sussex Coast Team, said: “Outstanding providers achieve high-quality care by managing their resources well. In all the sectors we inspect, there are many examples of excellent leadership – leaders who are visible and who engage widely with people who use services and staff, who promote a strong culture of safety, who put in place robust governance systems and processes, and who plan their resources well.”

Carole Andrews, Head of Social Care Governance at Regard, said: “Our audit process looks at all aspects of compliance – CQC fundamental standards, company policy and procedure, national best practice, and what we have learned as a company within the care sector over the past 20 years.

“This holistic and informed auditing approach adds critical evidence dimensions to the key lines of enquiry used by CQC and has compliance criteria which are aimed at achieving an ‘Outstanding’ inspection rating. Best practice is then circulated within Regard so that everyone learns from each other.

“As a result a service is never left in any doubt as to both external and internal standards and expectations. In the case of Douglas House we were able to evidence continuous improvements through audits.”

Audits are undertaken in ‘real time’ using an iPad and an automatic traffic light is generated at the end of the audit – ‘green’ means no action needed; ‘amber’ for up to 25% of actions generated across the audit; and ‘red’ for over 25% of actions generated across the audit. The electronic audit system automatically sets the timescales for any actions and the auditors give full feedback on what needs to be done before they leave the service.

The auditing team also spend time talking to service users and the staff to ensure ‘what is written on paper’ is translated into high quality support.

Four audits were undertaken at Douglas House over a 12 month period – two Quality audits and two Health and Safety audits with the team looking at all available evidence including service user documents, staff documents, policies and procedures, health and safety checks, medication administration records, accident and incident records, daily recordings, meeting records.

In October 2014 both audits were ‘amber’ with required actions identified. Four consecutive ‘green’ audits were achieved in 2015, followed by a CQC ‘Outstanding’ inspection rating in December 2015.

The inspector praised the safe and caring way that the service was operated and was particularly impressed by the way those who used the service were involved in decision-making about their own care.

The inspector’s report said: “There was a positive culture within the service. There were clear values that included involvement, compassion, dignity, respect and independence. The management team provided strong leadership and led by example.

“People were able to express their opinions and views and were encouraged and supported to have their voice heard. People were included in decisions about the running of the service and staff were encouraged and supported to question practice.”

The team at Regard believe that the formula for an “outstanding” rating is to keep service users’ wishes central to everything while ensuring there is a positive culture among the service team, backed by a strong audit department with real expertise.

Douglas House


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Specialism: Providing bespoke packages of care and support to young adults with a Learning Disability/Mental Health condition, Aspergers/Autism, those with forensic