Transcript Essential Standards & Implementation

FDAP Workshop
David Finney
Social Care Consultant
11 November 2010
Aims of workshop
Think about quality
 Fit for purpose
 Measurable change
 Continual Improvement
Think about excellence
 Exceeding the mark
 Going the extra distance
Focus of this workshop
 Care Quality Commission definitions
 Overlap with NDTMS, Supporting People, TOPS &
others
 Examples from the CQC “Provider Compliance
Assessment” document
 Think about – what we mean by outcomes – and
how this links with commissioners expectations
From Standards to Outcomes
 From ...“You will have.....
 “three meals a day, including at least one cooked
meal,....etc”
 To...“You demonstrate that ...
 “people who use services are supported to have
adequate nutrition and hydration”
From Standards to Outcomes (2)
 “The home carries out a needs assessment covering: Suitable accommodation & personal support
 Meaningful education, training and/or occupation
 Family/social contact
 Provision of disability equipment
 Method of communication
 Etc
 “People who use services experience effective, safe
and appropriate care, treatment & support that meets
their needs and protects their rights”
From Standards to Outcomes (3)
 From inputs to outcomes
 From processes to experience of people in services
 Generalised statements – allows for flexibility
 Example: Care is “centred on them as an individual and
considers all aspects of individual circumstances”
 Means – you need to demonstrate that ........
How to measure quality?
 Demonstrate that you have the evidence that
outcomes are met
 Say how the “experience of people using services” is
improved through service delivery
Outcome Evidence (1)
Principles
 Show how individual needs are met
 The views of people using services
 Describe the experience people have
 Say how equality, diversity & human rights are protected
 Show how people are directly involved in decision
making about:
 Planning their own care
 Running of the establishment
 Describe how people are kept safe
Outcome evidence (2)
Policies & procedures?
 List is not enough – not sufficient on their own
 Say how put into practice to ensure needs are met
 Impact they have on outcomes
 How help meet needs
 How people are involved in their development
 How they are reviewed
Outcome evidence (3)
Summary
 Best evidence comes directly from clients
 Focus on the experience of individuals
 Demonstrates:
 Appropriate assessments and care planning
 How risks are addressed and minimised
 How feedback has been listened to
 Results of any improvements
Great sources of evidence
 Written comments from service users or carers
 Notes of community meetings
Where do we find the CQC
outcomes?
CQC – what they expect (1)
Regulation 10
Registered person must:“Regularly assess and monitor the quality of the
services provided in the carrying on of the regulated
activity....”
CQC – what they expect (2)
Regulation 10
The Registered person must send to the Commission,
-when requested to do so:-a written report - (quality monitoring)
-Together with any plans for improving the service
So – Self Assessment is the key
Written Report?
The Provider Compliance Assessment Report (PCA)
Provider Compliance Assessment
Outcome 4 (Regulation 9):
Care and welfare of people who use services
Ensure effective, safe and appropriate, personalised care, treatment
and support through coordinated assessment, planning and delivery
4A
Provide evidence that demonstrates that people who
use services have safe and appropriate care, treatment
and support because their individual needs are
established from when they are referred or begin to use
the service.
Green
Yellow
Amber
Red
Amber
Red
Summary of evidence to support the outcomes described in 4A
Manage risk through effective procedures
4B
Provide evidence that demonstrates that people who
use services benefit from a service that has effective
procedures and arrangements in place which have
outcomes described in section 4B.
Green
Yellow
Summary of evidence to support the outcomes described in 4B
Provider Compliance Assessment
 Covers 16 Outcomes – in 16 sections
 Is a “living document” – continually updated
 Any outcome can be singly requested by CQC
 Asks for evidence for each “prompt”
 One for each “location”
How do providers fill in the
summary of evidence?
 Look at key principles in each outcome
 Assess for compliance
 Identify if an action plan is needed.
Lets look at an example!
 Outcome 1 – Involvement & information
 Note that there are some which apply specifically to
“Residential Substance Misuse Services” 1L
 Work through some of the prompts
Involvement & Information
Outcomes 1
General principles
 How do you –
 help people understand the options open to them – to enable them to make
an informed choice




Brochure
Rules and restrictions - explained
Treatment philosophy
Pre-assessment phase
 Make sure people can have a say about how their individual needs are met
 Assessment conducted in cooperation with a client
 Individual needs & preferences are highlighted
 How treatment programme meets their needs
 Includes equality & diversity information
 Involve people in the running of the service
 Community meetings
 Policy review
 Privacy & dignity – how maintained?
Personalised care & support
Outcomes 4, 5 & 6
 Make sure people have –
 Personalised care plan
 Involvement in drawing up care plan
 Involved in reviewing care plan
 Health issues are well documented
 Healthy living choices – including nutrition - outlined
 Cooperation with other providers/professionals
 Protocols or agreements in place
 Discharge arrangements are thorough (see 4N & 4O)
Safeguarding & Safety
Outcomes 8,9,10 & 11
 Safeguarding
 Cleanliness & Infection control
 Management of medicines
 Premises & equipment.
Safeguarding
Principles
 Take action to identify and prevent abuse
 Staff and s/u understand aspects of abuse – 7Q
 Guidelines for staff
 Respond appropriately when abuse suspected
 Have local safeguarding procedures available
 Have internal procedures regarding safeguarding
 Understand how diversity influences safeguarding
 Protect others from negative behaviour
 Specific procedures regarding money – 7M
Premises
Outcomes 10 & 11
 Regulations specify: Suitable design & layout – sharing & room sizes n/a !!
 Security
 Maintenance
 Specific issues
 Suitability – you explain
 Legislation – H&SAW, Fire, COSHH, DDA, Food, Elec
 Disposal of clinical waste
 Risk assessment – include self harm – 10P - RSM
 Space – toilets, therapeutic activity, outdoor – 10M
Staff
Outcome 12
 Requirements
 Recruitment – checks, qualified, legally in UK,
registered with professional body.
 Employment practice – job description, roles &
responsibilities
 Agency – need written confirmation of checks
 Expectations – (which accord with excellence)
 Communication
 Promote independence
 Identify & respond to changing needs
 Aware of company policies & procedures
Staffing
Outcome 13
 Sufficient staff
 Competencies
 Qualifications
 Skills
 Based on a needs analysis
 Management structures that enable effective
maintenance of staffing levels
 Respond to changing circumstances – leave,
sickness, vacancies, emergencies
Supporting Staff
Outcome 14
 Induction
 Skills for Care – 14E
 Learning & development (contributes to excellence)
 Based on needs of people using service
 Plan which covers mandatory & sector requirements
 Record of staff attendance
 Resources made available
 Supervision
 One to one or group – so can be peer support
 At a time & frequency agreed with line manager
Quality & Management
Outcome 16
 Relevant sources: Feedback from people who use services
 Observations
 Audits
 Adverse events, incidents, errors & near misses
 Comments & complaints
 Investigations into misconduct
 Expert bodies
What about your clinical governance arrangements?
The CQC system (1)
The Quality Risk Profile
The CQC system (2)
Wide range of sources of information
 Stakeholders
 Own surveys
 Direct contact with service – telephone or visit
 “Intelligence” – safeguarding, complaints, notifications
 Provider Compliance Assessment
Excellence (1)
SCIE have identified four key areas:
 Control over significant life decisions
 Day to day choices for the individual – decision to participate
 How a place is run – community meetings
 Management listen to staff & service users
 Evidence of changes as a result of listening
 Positive relationships
 Partners/family/friends /community – a process
 Staff treat with dignity – match this with challenge!
 Focus on people as individuals – personalise the programme
 Sensitivity to changes in peoples lives
Excellence (2)
 Meaningful activities
 Finds out what people want to do – emphasize agreement in
participating in treatment
 Seeks to develop independence – emphasize goals of treatment
 Community activities – challenge to consider external
 Organisation factors
 Quality assurance through review -learning organisation
 Commitment to excellent outcomes for service users
 Commitment to staff development
Introduction in Spring 2011.
The ongoing journey
 Have you got an approach to the CQC Assessment?
 What elements of excellence are you aiming for?
 Is there crossover with NDTMS, TOPS & SP Quality
framework?
 Is there a better way?
And finally
 Training – Consultancy – External review
 Simplex solutions
 Best of luck for the future
[email protected]
www.davidfinney.org.uk