CQC care home standards: How to move from good to outstanding

When your care home business is at full stretch trying to cope with staff shortages and strained resources, it can be a challenge to achieve an outstanding rating from the Care Quality Commission (CQC).

It’s a difficult time for social care, with care homes closing and losing skilled staff at an increasing rate – but maintaining high standards of care and a top rating from the CQC remains vital to your residents, their families and, ultimately, the viability of your business.

An ‘outstanding’ rating could make a huge difference in attracting residents at a time when COVID-19 has reduced occupancy rates.¹ On the other hand, an ‘inadequate’ rating on any of the CQC’s criteria or being placed in special measures could have the opposite effect – as well as requiring investment in order to rectify any issues identified.²

What it means for your care home to achieve an outstanding CQC rating

According to the CQC, an outstanding care home is:³

• Safe, with residents effectively protected from avoidable harm.
• Effective, with care, treatment and support achieving good outcomes and helping residents to maintain quality of life.
• A caring environment, where staff involve and treat residents with compassion, kindness, dignity, and respect.
• Responsive in shaping and delivering services that meet the needs of residents.
• Well-led ‒ the leadership, management and governance of the outstanding care homes make sure it's providing high-quality care, it encourages learning and innovation, and it promotes an open and fair culture.

Clearly, an outstanding rating is likely to be good news for any care home, helping it to attract more residents and staff based on a reputation for high quality care – but, with less than 5% of care homes rated outstanding in 2020⁴, how do you secure the top CQC inspection outcome?

CQC inspections and how to secure an outstanding rating

Whether you’re an old hand or this is your first time preparing for a CQC inspection, there is a lot to consider when it comes to securing that all-important outstanding rating.

Here are some of the top things you need to do to achieve an outstanding rating.

Care home safety

• Safeguarding ‒ ensure staff are well trained and they understand what’s expected of them. Safeguarding is crucial in keeping everyone safe.
• Managing risks ‒ manage risks to reduce the likelihood of an incident occurring. Should one happen, you’ll be better prepared to deal with it.
• Safe recruitment ‒ ensure you recruit staff based on your values, check suitability for the role, test core skills, and follow up on DBS checks and references.
• Safe staffing ‒ base your staffing levels on the needs of those who receive your care and support. It’s important to plan and review staffing levels and manage performance.
• Medicines ‒ if you train staff and assess competence, you will reduce the risk of an incident. Audits and proper investigation of incidents will show a willingness to improve.
• Learning to improve safety ‒ ensure all staff take responsibility for incidents, demonstrate learning and make improvements. Consider implementing technology to help with this.

Effective care delivery

• Legislation, standards and evidence – make sure you deliver care in line with legislation and that everyone understands the legislation. It’s crucial to communicate key changes and document this as you go.
• Staff skills, knowledge and experience – make sure your staff are competent before they deliver care. Customise inductions, continually develop staff and use technology to keep track.
• Effective retention – provide evidence that you recognise how low staff turnover benefits the standards of care. Demonstrate how you value your staff with support, wellbeing and incentives.
• Staff support – make sure staff know what’s expected of them. Supervise and support, get their feedback, follow performance management good practice and develop their skills.
• Adaptation and design of premises – make sure you carry out safety checks on your equipment and premises. The environment should reflect people’s needs and protect their dignity.

A caring environment

• Kindness, compassion and emotional support ‒ ensure these are part of your culture and your staff are proud to deliver. Consider whether the service you’re providing would be good enough for your own friends and family.
• Involving people, providing information and accessing support ‒ be proactive in sharing information, empower staff to deliver what’s needed, and create a culture where staff seek to support people.
• Privacy, dignity and independence – demonstrate human rights principles and document service users’ beliefs and needs. Honour differences and create policies and procedures to avoid discrimination.

Be responsive to people’s needs

• Care plans – make sure care plans are detailed, and clearly describe treatment and support needs. Include information about service users’ conditions and how they should be involved in their care. Plan care with the person, not for the person.
• Maximising independence – make sure staff understand the important of independence and encourage activities. Host the activities and help people achieve their personal goals.
• Person-centred care – provide a consistent person-centred approach to care, work closely with people to understand what’s important and involve them in decisions and regular reviews of their care.

Run a well-led care home

• A positive culture ‒ put people at the heart of your business. A positive culture starts at the top so managers and leaders should be open, visible and approachable. Avoid creating a blame culture.
• Vision, values and strategies ‒ make sure your vision is person-centred. Involve your staff in creating and renewing your vision and values and monitor progress.
• Knowledge, experience and integrity ‒ appoint senior staff who have the ability to run a successful care service and who understand CQC standards. Ensure they lead by example and develop succession plans.
• Governance – put in place clearly documented management structures at all levels and ensure legal requirements and implications are understood.

For a full list of the criteria and how to achieve an outstanding rating, it’s worth reading the Good and Outstanding Care guide for further information. Alternatively, if you are preparing for your first CQC inspection, read our guide to getting your preparations right.

Finally, if you need help we’re ready to discuss managing your risks, care insurance or how to recognise and reward your employees with employee benefits.

^Sources:

<sup>1. https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/publications/national-information/The-state-of-the-adult-social-care-sector-and-workforce-in-England.aspx
2. https://www.skillsforcare.org.uk/Documents/Standards-legislation/CQC/Good-and-outstanding-care-guide.pdf
3. https://www.cqc.org.uk/what-we-do/how-we-do-our-job/five-key-questions-we-ask
4. https://www.nao.org.uk/wp-content/uploads/2021/03/The-adult-social-care-market-in-England.pdf</sup>