The examples below provide insight into how other Good or Outstanding rated services are succeeding in this area of inspection.
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Using chatterboxes to build meaningful relationships and interactions
The provider was always striving to improve through ongoing evaluation of care. They identified that sometimes staff were not fully interacting with people and discovered that most staff simply didn't have the confidence or skill to start conversations about simple day to day things or if they did, the conversations soon ran dry.
The concept of 'Chatterbox' was born, a bright, colourful box full of simple questions, put together by people that supported the team to start easy and meaningful conversations. During staff handover, staff took a card, read their question and committed to ask every person they care for that day the question.
Staff and relatives were asked to sign to pledge to 'build meaningful relationships' with people to break down barriers and they received a badge and certificate in recognition of their commitment. The cards were refreshed regularly to ensure the conversations kept flowing. People, staff and relatives embraced the concept and they had meaningful interactions.
Read more about this service here.
Care provider: Byron House Care Home
Date published: January 2023
Supporting people around their loss of communication fears
The service had taken innovative steps to support people to be able to express their needs, views and wishes. For example, a staff member worked closely with a person and identified the person was particularly fearful of losing their ability to verbally communicate due to a health condition.
This staff member went above and beyond to find ways the person could continue to express themselves and communicate. The staff member researched facial exercises and these exercises became a part of the persons everyday routine The staff member and person successfully learned some basic sign language together and looked at ways to communicate through the written word, poetry and art.
Read more about this service here.
Care provider: Right at Home - Isle of Wight
Date published: November 2022
Treating all concerns and complaints seriously
Complaints and concerns are a part of life and should be embraced. If presented constructively, these issues can really help you to make the service better. The best way to grow is to learn from critical feedback.
We have to accept that nothing will ever be perfect; what works for one person and makes them happy and content could cause another person upset. There are so many problems that can arise from ignoring or not dealing with complaints in the hope that the person goes away.
These matters can be a big deal to the person who raised the complaint. That’s why it’s so important to take things seriously and make the appropriate adjustments.
If you want to be a good and outstanding manager, you should be willing to seek criticism and feedback.
It should be important that you know what you’re doing wrong or where your service can be improved. This will help the manager to develop their own skills in managing concerns and complaints effectively, which will often mean drawing on the wider staff team.
Working together with the people who raised the complaint and others in your organisation dedicated to improvements can help you to strengthen the quality of care provided.
Finding an acceptable resolution will often not just benefit the person who raised the original complaint, but often many other people you support.
Read more about this service here.
Care provider: Castleford House Nursing Home
Date published: October 2021
Responding to people's concerns about communication
People's individual communication shaped how staff responded. For example, one person had an out-of-area placement some distance away and was prone to experiencing anxiety. Staff recognised making lots of long car journeys to a new placement might further enhance the person's anxiety. Staff instead used FaceTime for the person to speak with their host and have a look at the placement on multiple occasions before they went. Staff told us this reduced the person's anxiety whilst allowing the person to feel in control of their decision.
Staff reassured people that differences in speech and dialect were unique and special to the person. When one person expressed apprehension about an opportunity because of their dialect and prejudices they may encounter, staff intervened and reassured the person and further encouraged them. Staff checked on them regularly to ensure the person was happy and check whether they needed further support.
Read more about this service here.
Care provider: Shared Lives Scheme - Coventry City Council
Date published: April 2020
Involving relatives
The provider and staff were innovative in their thinking about how people and relatives could be involved and kept informed about matters concerning their care.
For example, the chief executive wrote a regular blog which was shared with services, and 'The creative life’ magazine was regularly published and shared throughout the organisation with easy access for staff and people. It contained information ranging from legislative changes to good news stories from people. The Doncaster service had featured four times in the last edition.
People spoke proudly of having their story published. One person said: "I went to town on the bus to meet my girlfriend. Look, it's there in black and white!" Parents had also been interviewed and filmed for the magazine.
Read more about the service here.
Care provider: Creative Support - Doncaster Personalised Services
Date published: February 2020
Seeking feedback, securing engagement
People's feedback was regularly sought, and innovative ways were used to gain feedback which took account of people's individual communication methods.
Easy-read format questionnaires were used, staff supported people with picture cards and other communication aides which enabled people to express themselves. Expert-by-Experience (EXE) were employed to support people to have a voice. Feedback was used to continuously drive improvements.
Read more about the service here.
Care provider: Consensus Community Support Limited
Date published: December 2019
Outstanding care leading to compliments
Staff were particularly skilled when exploring and trying to resolve any conflicts and tensions. A staff member supported a situation in which the person living with dementia was confused about the staff member's identity, which made their role particularly difficult. They interacted with the person living with dementia and their partner in a way that wasn’t confrontational. The staff member built up a trusting relationship over time and visited the person in their own time when the person became unwell.
These levels of support regularly resulted in compliments about the quality of care being received. In the year leading up to their 2019 CQC inspection, the service had received 189 compliments from various sources which demonstrated the service was meeting its vision of providing an exceptional quality of companionship for people.
Compliments included: "Their level of understanding and sensitivity is exceptional and they’ve consistently proved to be intelligent, caring, compassionate and generous personal assistants with my mum.” Another stated: "In my opinion, the provider and their team go far above and beyond the level of attention that might reasonably be expected,” while another said: "No Place Like Home provides a fantastic service, giving exceptional care and attention."
Read more about the service here.
Care provider: No Place Like Home
Date published: April 2019
Openness and transparency from the start
Information about complaints was also in the service user guide that each person was given a copy of when they started to use the service.
The service user guide was included in the care files kept at people's homes. This showed people were provided with important information to promote their rights.
Read more about the service here.
Care provider: Community Support Service (D.D.H. Services Ltd)
Date published: March 2019
Outstanding approaches to involving people
The service focused on meaningful conversations between individuals. The registered manager and staff made extra efforts to have real conversations, humour and banter with people as we went around the home. The provider ensured staff knew people's personalities and are 'brave with banter', and adapt to people's language and sense of humour.
Staff take time to sit with people to make sure they’re happy and to help them engage with a film and others. Staff had cultivated relationships between people living at the home and there were little groups of people having positive 'conversations' regardless of their level of understanding.
One person 'chats' to staff using inaudible words but staff acted positively and nodded and made comments to help them feel understood. Staff encouraged them to talk about London where they’d lived, which resulted in more coherent words being used.
Staff also used laminated cards of prompts showing particular items and activities of interest to each individual. Each person had a list of activities and things they particularly liked to do to remind staff of useful engaging topics. They used these when they needed an idea to help engage someone, but also to add new opportunities for people such as helping prepare for home events. For example, cards called 'my favourite…' reminded staff that the person liked a particular TV show, particular song, actor, game and food. One person, for example, liked to sort jewellery and have their nails painted, both of which were happening.
Read more about this service here.
Care provider: Wisteria House Dementia Care Ltd
Date published: January 2019
Tracking issues via cloud-based systems
The management of information is key to a successful home care service, and we have leading cloud-based systems in place to support this to ensure that issues, events and successes are shared amongst the appropriate people and responded to efficiently.
Read more about this service here.
Care provider: Carefound Home Care
Date published: April 2018
Consulting with your people
Each month, people who use our service complete a consultation form (which we call a listening form). If they’re unable to complete this due to physical problems, a carer writes down their views in quote form.
If someone has a cognitive impairment, then a carer completes it with them using evidence e.g., “do you enjoy the food?” – “(resident) eats well and appears to enjoy their food. They have gained/maintained a weight of...”
Read more about this service here
Care provider: Ebury Court Residential Care Home
Date published: April 2018
Meeting with residents and relatives
The service provided multiple opportunities for people to provide feedback and for their voices to be heard through meetings arranged for people using the service and their relatives. This included one-to-one meetings with key workers and other staff, as well as weekly coffee mornings with bigger groups which generated lots of discussion and feedback.
Care provider: Anonymous
Date published: April 2018
Alternative ways to gather feedback
To support people living with dementia who were unable to complete the provider’s survey, the registered manager considered alternate ways their voices could be heard. This involved using a ‘photo-elicitation’ technique where conversation and views are triggered by using photographs.
Using a photograph to represent the area of the service they wanted people’s views on enabled them to gain feedback. For example, 10 people were shown a photograph of a care worker and asked what this person meant to them. Their comments included: “They are the carers and they are very good”, “They are really helpful,” and “[care worker] rings the doorbell before they come in”. etc.
Care provider: Anonymous
Date published: April 2018
Acting in a timely manner
Creating and maintaining an open culture with everyone connected to a service ensures our foundation for positive improvement is solid. Naturally occurring dialogue between those using our service and our staff/management enables early interventions which allay concerns before complaints are ever considered.
When a person highlights a concern or suggestion, we listen attentively, then respond in a timely manner, usually by email, to generate a paper trail and record. People need to see we resolve any issues immediately and consider suggestions seriously. Responses are always from the manager and updates are regularly sent if it’s an ongoing project.
Read more about this service here.
Care provider: Hale Place Care Homes
Date published: April 2018
Using volunteers to collect feedback
The service had found success using volunteers to support the gathering of feedback from people who needed care and support.
The volunteer would visit people and give them time and the opportunity to express themselves, be heard and discuss things the person may not have shared with the care staff supporting them. The feedback was then shared back with the service to reflect and act upon.
Care provider: Anonymous
Date published: April 2018
Feedback drives improvements
Feedback from people had been an integral part of the re-design of the day centre, along with best practice recommendations from good and outstanding providers from Hospice UK. Details of other improvements made following feedback were displayed around the hospice so people could see their views were listened to, taken seriously and acted upon.
Care provider: Anonymous
Date published: April 2018
Seeking feedback
Area managers undertook monthly visits to seek feedback from people who needed care and support and their family members. This approach also encouraged direct and regular feedback being provided to the service’s registered managers
Care provider: Anonymous
Date published: April 2018
Flagging different types of feedback
The service survey report used different headings to categorise people’s feedback. These included ‘celebrate success’, ‘what are our customers saying about us’ and ‘opportunities for improvement’. The survey also included comments from the questionnaires.
Care provider: Anonymous
Date published: April 2018
Building relationships with other staff members
The cook at the service is given time to build relationships, sitting with residents and finding out what they would like for their tea and to chat about old local recipes that many people could identify with. This had led to a lively conversation where people became animated and engaged.
Care provider: Anonymous
Date published: April 2018