While the Care Quality Commission may have abandoned its star ratings system for residential care services, one provider has created its own version in a bid to drive up standards. Michael Fullerton explains.
When care regulator the Care Quality Commission (CQC) withdrew its star rating system for residential care homes at the end of 2010, some providers in the sector breathed a sigh of relief. But Care Management Group (CMG) took a different approach.
Worried that the regulator’s new system would remove the incentive for continual improvement, CMG decided to design its own internal rating scheme to assess quality across its service models. The challenge in producing this new system was to keep the best of the old, while creating a new method to ensure consistent standards and help to improve staff morale.
The new categories that the CQC uses to judge a care home are ‘compliant’ and ‘non-compliant’, which are helpful in ensuring that fundamental standards are maintained. It is by no means simple to gain the regulator’s stamp of approval under this new regime, but CMG managers wanted their services to be exceptional, rather than just acceptable. They wanted to recognise services that made the effort to provide above standard services.
“The old star ratings scheme helpfully outlined the specific areas that managers need to focus on to achieve excellence in care and support,” says CMG’s chief executive, Peter Kinsey. “We wanted to learn from this and so instigated our own Quality Ratings Framework to focus on those key elements, while ensuring we hit all of the CQC’s current criteria.”
Quality Ratings Framework
To ensure the new internal rating scheme was the most rigorous possible, CMG’s senior management team, along with managers and service users, set about designing a framework. The end product was the Care Management Group Quality Rating Framework, which has been rolled out across CMG’s 98 services.
A crucial element of the framework was to include service users in designing the criteria by which the quality of care and support is judged. The senior team invited members of the Service User Parliament – the forum in which service users voice their opinions – to represent their peers and help to frame the new rating system.
“It was great to be involved in these meetings,” says Peter Lines, a CMG service user. “We talked about key issues like health and safety and how we can raise our concerns.”
The framework focuses on eight main areas, all underpinned by the principle of person-centred active support (PCAS). The areas are: service user voice, outcome focus, documentation, staffing, environment, safeguarding, health, external relationships and reputation. This provides clear criteria for each service to be judged upon, resulting in an evidence-based rating.
Once the eight key assessment areas had been agreed, the CMG team developed a four-phase assessment process for the scheme.
Phase 1: Service managers assess their own services against the agreed criteria every month, and submit to regional directors.
Phase 2: Regional directors independently assess the services every three months, unannounced, and then work closely with the managers to review any discrepancies, identify strengths and weaknesses, and draw up action plans for any improvements. Future regional director audits will also consider previous recommendations and how effectively these have been implemented.
Phase 3: Kinsey and other senior directors review and moderate the regional directors’ scores to ensure consistency in assessment across all CMG services.
Phase 4: Once a year, CMG’s senior Quality Support Team will carry out an independent audit of each service, timed around its scheduled CQC inspection.
The new system is designed to mirror the old CQC star rating mechanism with five results categories: outstanding, very good, good, satisfactory and poor. The CMG ‘outstanding’ rating equates to what a 4-star rating would have been under the CQC’s old system, highlighting the underlying focus on quality.
Pam Kujeke, service manager for Brickfield Road, a CMG residential service in Thornton Heath near Croydon, says: “We take the Quality Rating scorings very seriously, always keeping them in mind as we go about our day-to-day duties. It has really helped focus our attention on the highest standards and drive up quality across the board.”
Since implementing the framework CMG has audited all its services in England and Wales, with 68% of its 98 services achieving a ‘very good’ or ‘outstanding’ rating.
Importantly, the Quality Ratings scheme has helped demonstrate the standards of care and support across the board at CMG, and also helped to reinforce a culture of continual improvement driven by self-evaluation.
Ensuring service users have a voice
The underlying aim of the rating scheme is to ensure that service users are ultimately the judges and the beneficiaries of all improvements. The four-phase assessment process has ensured that all staff are fully aware of their priorities for care and support and that it remains at the forefront of all carers’ thoughts when they are working with service users on a daily basis.
Shaun Rendle Hunt, manager of the New Dawn residential service near Norwich, says: “The Quality Rating scheme has really helped embed best practice throughout New Dawn. Person-centred active support is no longer something we need to think about – it has become second nature. Most importantly, this has helped our service users become more independent, confident and happy.”
Service users remain engaged with the process they helped to design with the CMG Service User Parliament meeting. Here, on a monthly basis, they come together to review the systems of support being offered and gather feedback for improvements to the Quality Ratings programme. This has given service users a platform to be involved in the care they receive; they have been empowered and made aware of their rights to hold staff to account.
Furthermore, the monthly manager audits have made it easier for managers to feedback to other stakeholders and inform newsletters for service users’ families, care managers, advocates, social services and community nurses. Families have already noticed the difference and provide positive feedback to staff.
This difference has been felt by the staff too, with improved morale ensuring a low rate of turnover. Rendle Hunt adds: “This scheme has helped staff feel valued, recognised and supported – which is crucial for a happy and successful service.”
Such is the success of the new ratings scheme, CMG is using it to develop best practice examples from its ‘outstanding’ services to be shared with those who continue to strive for improvements.
And the ‘outstanding’ services are not resting on their laurels. They have formed a working group to develop ideas to continue to make improvements.
The new scheme has been built to stand the test of time and to accommodate continued improvements, as well as to absorb any legislative or regulatory changes that may come into being.
About the author
Michael Fullerton is director of quality and clinical care at CMG.
This article first appeared in the October/November 2012 edition of Learning Disability Today. To find out more about the magazine, and how to subscribe, click here.