CQC Updates, Maintaining Quality

1. CQC Updates, Maintaining Quality Paula Eaton & Sarah Greaves 10th October 2019 1

2. Smiling matters: oral health care in care homes What we did • Dental professionals accompanied our adult social care inspectors on 100 routine inspections. What we found • most had no policy to promote and protect people’s oral health (52%) • nearly half were not training staff to support daily oral healthcare (47%) • 73% of care plans reviewed only partly covered or did not cover oral health • it could be difficult for residents to access dental care • 10% of homes had no way to access emergency dental treatment for residents

3. Smiling matters: oral health care in care homes • We recommend • A cross-sector approach including: • sharing best practice • repeating and reinforcing the guidance • mandatory staff training • oral health check-ups for all residents moving into a care home • a multi-agency group to raise awareness

4. Smiling matters: oral health care in care homes • Questions for inspections • Do all staff have training in oral health care? • Is this part of staff induction and mandatory training? • Are staff confident and know what to look for to identify a deterioration in oral health? • Do staff consider poor oral health when assessing reasons behind weight loss, infection, or tissue viability? • How do you ensure oral health care is assessed, considered and delivered as part of a person’s care plan? • Are staff aware of and assess people’s oral health using NICE guideline NG48 and an oral health plan developed? • Do people have easy access to tooth paste and brushes and denture cleaning fluid and how are people supported with oral health?

5. Review of restraint, seclusion and segregation • Overview • At the end of 2018, Matt Hancock, the Secretary of State for Health and Social Care, asked us to look at the use of restrictive interventions. • The initial review concentrated exclusively on the experience of people cared for in segregation on a mental health ward for children and young people or on a ward for people with a learning disability or autism. • Currently, we are looking at the use of restrictive practices in a wider group of settings, including low secure and rehabilitation mental health wards and adult social care services. • Recommendations will be made in our report in March 2020

6. Medicines in health and social care • Overview • We know that people’s physical and mental health outcomes improve when medicines are used in the best way. When they are not prescribed or administered correctly they can cause harm. • We want to encourage improvement by sharing what we have found through our regulatory work and giving examples of how some providers have reduced these risks. • What we did • We analysed over 200 inspection reports, 100 enforcement notices and 1,500 National Reporting and Learning System (NRLS) and statutory notifications from providers.

7. Medicines in health and social care • What we found • There are many examples of how good use of medicines can lead to person centred care and better outcomes. However, medicines errors do happen and we identified common areas of risk: • Prescribing, monitoring and reviewing • Administration • At transfer of care between services • Reporting and learning from incidents • Storing, supplying and disposal • Staff competence and workforce capacity

8. Maintaining Quality • Person centred practice • Ask people for feedback and act on this • Develop an improvement plan • Support and value staff • Keep up to date with best practice guidance

9. Being outstanding in Well Led • People who use services, relatives and staff speak highly of the service • Effective monitoring and quality assurance • 75% of services had a registered manager in post consistently • Open culture – people who use services/ staff/ relatives shared views and issues • Good leadership extends beyond the manager and those values inspire staff • A can do, will do attitude – staff dedication • Strong links with local community • Safe care actively promoted – effective oversight of care and staff communication

10. Top tips for achieving an outstanding rating • Set out your ambition to be outstanding – It has to start at the top • Involve staff, residents, their relatives and other health professionals in developing strategies to help you achieve your ambition • Determine where you are now and identify the gaps you need to plug • Can you easily identify the outstanding features in your home? Will your staff, residents, other health professionals support your view? • What makes a difference between good and outstanding is often how the service pays attention to detail – simple things done well that have a significant impact on the people using the service • Think about how you will sustain high quality performance • Work hard on ‘your’ ability to demonstrate the impact your intervention is having on people. Ask yourself whether people, their relatives, staff and other professionals will corroborate your assessment of your quality when asked.

11. Links to reports • Smiling matters: oral health care in care homes • https://www.cqc.org.uk/publications/major-report/smiling-matters-oral-health-care-care-homes • Review of restraint, seclusion and segregation • https://www.cqc.org.uk/publications/themed-work/interim-report-review-restraint-prolonged-seclusion-segregation-people • Medicines in health and social care • https://www.cqc.org.uk/publications/major-report/medicines-health social-care

12. Thank you www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm Paula Eaton, Inspection Manager Sarah Greaves, Inspector