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

Recommendations from good and outstanding providers

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

Recommendation
All staff receive regular planned supervisions with either their registered manager or manager.
Supervision and support is provided outside of formal meetings.
Sufficient time is set aside for supervisions to cover the support needed.
Supervision is structured but flexible, enabling the supervisor and staff to discuss issues and have difficult conversations if necessary. An established template is used to record notes from the supervision.
Supervisors and managers regularly observe the performance of staff beyond their initial induction, including unannounced assessments and support. This helps to value achievement and challenge any slipping into poor practice.
Staff understand what they need to do to achieve and are given clear guidelines on the quality level expected of them.
Staff are supported to meet the needs of the service by the registered manager / manager. Delegated tasks and progress towards longer-term goals are regularly reviewed.
Staff supervisions provide opportunities for staff to raise concerns or suggestions for improvement.
Supervisors / managers record details of supervisions and staff performance using an established template. This includes recording details like the date of the supervision.
The service empowers staff to develop their skills through training and personal development to help drive improvement. Every member of staff has a personal development plan.
All staff have access to ‘out of hours’ support and supervision ensuring they have access to expertise at all times.
Staff appraisals include a focus on what has been achieved since their last one, new aims and objectives and a training needs analysis.
Staff set their own goals as part of the appraisal process. Supervision provides an opportunity to reflect of these and agree actions.
The service ensures that those involved in the supervision of others are effectively trained and capable to do so.
The service support their staff through personal challenges, as well as professional ones.
The service ensures that supervision happens and do not regularly cancel or rearrange them.
Supervisions should be factually evidenced using an established template and not personal.
Reviewing stakeholder feedback, including form people who need care and support (and / or their families) can add value to each supervision.

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.

Either the registered manager or a deputy manager were on duty seven days a week, ensuring there was managerial support to the staff every day. Family of people who used the service felt this was particularly reassuring if they could only visit at the weekend because there was always someone on duty who could give them a full update on their relative's care.
Staff knew who to go to for support, seek advice and put forward suggestions and when to refer to the registered manager. Staff knew what was expected of them because enabling processes were in place for them to account for their decisions, actions and performance. The service actively consulted with staff taking on board the suggestions that staff made to improve the lives of people who used the service.
The registered manager and owner regularly did an evening shift not to provide cover but because they felt this was often the time people needed a listening ear the most or when they would talk about what kind of day they had.
The service always reviews stakeholder feedback as part of each supervision. In addition, if the care worker has experienced any incidents or been exposed to challenging behaviour, the supervision provides an opportunity for effective welfare discussions.

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
“All the staff know what they are doing. There isn’t one of them who isn’t skilled in their job.” Person who needs care and support
“The manager is always available and we have regular supervision. We talk regularly about what we are doing and reflect on our practice.”
Care worker
“We are encouraged to ask questions and to share our knowledge. They are quick to recognise enthusiasm and willingness to learn and they support you to develop confidence and skills.”
Care worker
"I've had more training here than in the 10 years in my old job. Our training is done before you need to use it. It's constant."
Care worker
“We all attend team meetings which are also very regular. The management team are always open to suggestions and new ideas.”
Care worker
“They seem to care as much about us as we do about the clients.”
Care worker
"Management tell you when you are doing a good job. They are supportive and thank you for all your hard work."
Care worker
“They encourage you to take on new responsibility and they believe you can do it. I have gained so much confidence since I started to work here.”
Care worker
"There is really good team work, good management and lots of opportunities for discussion." Care worker
“I can make a positive difference to the clients I support. The back-up and support I receive is fantastic.”
Care worker
"I am amazed at the things staff do for people, nothing seems impossible for them."
Independent advocate
Inadequate and requiring improvement comments
“Some carers are good and some are bad but that is life…they are not taught properly." Person who needs care and support
"Some staff seem well trained but others don't seem to have a clue."
Family member
“We’ve only had one staff meeting in the past four months.”
Care worker
“People die and we're not told; we're not given any support with that at all."
Care worker
"I just do my job, there is no point fighting, the management don't listen anyway."
Care worker
"I had one training delivered here but I don't remember now which one. The rest of my training I had in my previous job."
Care worker
"On my first day they took me to my first house. We walked in and they showed me where the gloves and medication were. They told the person they would be having a shower and then handed over to me. There was no direction or guidance; I was left to do it." Care worker
"All my training is out of date. I hadn't worked in care before I started here so I needed proper training but instead you get this multiple choice internet test."
Care worker