The following recommendations, examples and quotes originate from a review of over 250 Care Quality Commission (CQC) inspection reports and associated discussions with providers.

Recommendations from good and outstanding providers

Skills for Care’s review of inspection identified some recurring factors that seemingly contributed to a good or outstanding rating.

Ensure managers and leaders always lead by example and act as role models for the wider staff team
Ensure people who need care and support and their family / advocates know the managers and leaders of the service (e.g. the manager has an open door policy and / or visits people in their own homes)
Deliver a service where staff are as comfortable and relaxed when managers and leaders are working alongside them as at any other time
Deliver a service where relationships across the entire staff team is strong and productive. Ensure staff are proud of both what the service and their managers and leaders
Ensure managers and leaders understand CQC regulations and associated legal requirements and implications
Ensure managers and leaders understand their role and responsibilities and are accountable for ensuring effective governance
Celebrate achievements, including those attained by staff and the people who need care and support (e.g. achievement of qualifications, local awards, sharing positive feedback)
Ensure managers and leaders are able to challenge and change policies and procedures and are not tied to “doing things how they’ve always been done”
Recruit and develop managers and leaders to have the required qualifications and sector experience to run the service effectively
Ensure managers and leaders have the experience and capacity to deliver upon the aims and objectives of the organisation. Succession plan to ensure there are no gap periods between new and old registered managers
Where appropriate, ensure the registered manager has the ability to takes an active role in directly delivering care and keeps such abilities up to date with latest practice
Ensure managers and leaders can account for the actions, behaviours and actions of staff
Ensure managers and leaders deliver care that meets national standards (e.g. Care Certificate, NICE standards etc.)
Provide time for managers to get to know staff, the people who need care and support and others (including family / advocates, healthcare professionals and community links)
Actively seek best practice from across the sector (including membership and alignment with leading health and care organisations) and use this knowledge to help challenge poor practice wherever it may occur
Ensure managers and leaders empower others through effective delegation and opportunities to develop skills and expertise across the staff team

Practical examples from good and outstanding providers

The following examples are anonymised from CQC inspection reports. These practical examples have been used by the CQC inspector to help justify the reason for the good or outstanding rating.

In addition to nursing and social care qualifications, the registered manager had obtained a teaching qualification in order that she could provide flexible training to staff throughout the year in addition to training provided by external training companies
The registered manager had recently visited a person who used the service after they had been admitted to hospital. The registered manager had not been satisfied with the levels of care at the hospital and had liaised with community nursing professionals and family / advocates to ensure the person could be brought back to the service sooner than anticipated
The provider was committed to driving improvement through nurturing staff and developing their managerial and leadership skills. They introduced a leadership academy which ran three management development programmes suitable for beginners to more senior staff.
The academy is run by managers within the provider organisation and the registered manager was a trainer at this academy. Some of the successes from this programme have included one member of staff undergoing several promotions, eventually achieving a management position
The registered manager was not afraid to challenge other agencies or partners on behalf of the people who used the service where they felt necessary. For example, the service had managed to secure funding for an adapted bed for a young person who used the service. The application had originally been refused, as the bed was extremely expensive. However, this was challenged by the service, as the bed helped the individual to be independent and autonomous and this was felt to be hugely important in enabling the person’s self-reliance for the future. The challenge was successful, helping enable the young person to continue to live as independent a life as possible

Telling signs – quotes from CQC inspection reports to indicate good or poorer quality care
The following comments have been taken from CQC inspection reports. Whether part of a formal survey or captured in the day to day operations of the service, such feedback can be hugely valuable to helping shape a successful service. If similar type comments are expressed within or about your service, these can act as indicators of success or signify for improvement.

Good and outstanding comments
"I cannot speak highly enough about the manager. I am so well and it is down to their care that I now want to live to be 100 and I never dreamed I would after my husband passed away?"
Person who needs care and support
“The wonderful care dad received is a product of the leadership and direction given by the staff and management team whose complimentary skills were much in evidence.” Family member
What they do is excellent because they manage such a diverse group of people so well and they fine tune their response to people constantly to make sure they are protected.” Family member
“The owner’s wealth of experience has created a wonderful care home. She always appears to be full of energy and enthusiasm and has a hugely positive attitude – all this must reflect on and encourage her staff to do likewise.”
Volunteer visitor
“The registered manager is knowledgeable about every aspect of the service. They know about people, relatives and staff”
Care worker
“The senior staff do regular scenario training. This keeps us responsive to people’s needs and helps us understand how to keep improving the care and support we deliver.” Care worker
Inadequate and requiring improvement comments
“Talking to the manager is like talking to a brick wall”
Family member
We’re satisfied with the carers, its leadership and management that are needed”.
Family member
"There is no organisation. It stops us from doing our job properly"
Care worker