QUALITY ACCOUNT 2022/2023
Contents
1. Statement on Quality, a foreword from the Chief Executive
2. Our Purpose
3. About CareTech
4. Our Divisions
5. Our Values
6. Services Commissioned by the NHS
7. Celebrating Outstanding Services
8. Participation in Quality Networks
9. Progress on Quality Objectives 2022/2023
9.1. Quality Strategy, Assurance & Improvement Framework
9.2. Clinical Governance Framework
9.3. Open & Learning Organisation
9.4. Safety
9.5. Corporate Risk Management
10. How we monitor our services
11. What our patients say about us
12. Quality of Life Measure
13. Our People, Our Greatest Asset
14. Investing in our Learning Development Programmes
15. Quality Objectives for 2023/2024
15.1. Ensuring a Safety-First Approach
15.2. Focus on the accuracy and ability for all staff to recognise, respond to, record and report risk appropriately and in a timely manner
15.3. Developing a Learning Culture Across the Organisation
16. Community Engagement
17. Complaints & Compliments
Our focus on quality, effective governance and oversight drive our commitment to continuous transparency and effective engagement with the people we support, our staff, wider communities, our funders and health partners help us achieve our goal - to deliver Extraordinary Days Every Day.
Amanda Sherlock Group Executive Director Compliance & Quality
1. Statement on Quality, a foreword from the Chief Executive
I am once again proud to reflect on the achievements of everyone that is part of the CareTech family for delivering Extraordinary Days Every Day for this landmark year. This year's Quality Account explains how we performed against our key quality objectives last year and sets out our priorities for the year ahead.
In the autumn of 2022 the company that I as CEO and my Brother Farouq as Executive Chairman have built over 30 years returned to private ownership. The direction of travel for CareTech has always been to place every child, young person or adult receiving support at the very core of all the decisions that we take. The changes to our ownership have given the Board and Executive Team an opportunity to consider how we maintain and build on our vision, values and objectives for the quality and safety of education, care and support across our national and international service portfolio.
We said goodbye to our Non-Executives who brought wisdom and challenge to our decisions. We have welcomed new partners to our revised corporate structure and they already have contributed fresh insights and ideas to our direction of travel for quality.
I am pleased that we have continued the positive trajectory for services registered and regulated with all regulatory bodies across the UK. In England, the Adult and Specialist services have continued to grow and thrive through a combination of a strong internal focus on compliance and quality. Our partnerships with NHS and Local Authority partners to shape and modernise models of care ensure that we deliver person-centred and empowering care and support.
As a Group, our values remain unchanged - Friendly, Positive, Innovative, Empowering and Person-Centred. These values are core to the way in which we take decisions every day, from our values-based recruitment programme to the CARE4 programme providing leadership and direction to our ESG commitments.
This Quality Account is both a re-statement of our corporate commitment to drive high quality support and care but also to continue being a leading provider of high quality care and support that provides an integrated care offering with measurable and demonstrable successful outcomes for all individuals in our care.
CareTech continues to realise the benefits of our programme of investment in technology and digitalisation. The 100 Voices Project that sought to make the technology developed by CareTech's subsidiary Smartbox - available to individuals in a wide range of our services - continues to expand. Alongside new integrated management information systems, we are developing continuous quality improvement programmes based on real time data and evidence of what works for individuals in our services.
The implementation of an integrated clinical governance model across our adult services is supported by a quality performance dashboard and has given us a clear line of sight across the organisation on quality. It has enabled an approach to quality and safety that 'measures what matters' to the day to day lives of individuals in our Adult and Specialist services. As CEO, I actively engage with our services and with our employees to listen to and discuss ideas that support our organisation and commissioners to deliver innovative solutions to the challenges that the sector faces - not least recruiting and retaining a high-quality, values-driven workforce.
Whilst the last year has undoubtedly presented some challenges, I am confident that the focus of the Group on delivering high quality specialist social care, education and health support has remained constant. With our sustainable quality infrastructure, expertise and commitment, I am confident that the achievements made this year on quality build on already strong foundations we will continue to evolve and position ourselves as a long-term strategic partner to commissioners.
I hope you enjoy reading our progress we have made against last year's objectives and I can confirm that the content of this report has been reviewed by the Care Quality Governance Committee and to the best of our knowledge, the information contained in this report is accurate.
Haroon Sheikh
Group Chief Executive Officer
2. Our Purpose
Our vision is a world where there is equal opportunity for a life fully lived. To play our part in this vision, we enable children, young people and adults with complex needs to make their own life choices, and to develop confidence and independence to live, learn, thrive and engage, building better futures. We refer to this as providing - Extraordinary Days, Every Day.
3. About CareTech
CareTech Group is a leading provider of healthcare, education, social care, training and technology innovations. For close to 30 years, we have offered specialist, high-quality services for children, young people and adults with complex needs in more than 550 locations in the UK and internationally.
Our portfolio of services, delivered by 12,000, staff, supports a range of people with mental health needs, learning disabilities, autism, acquired brain injury, physical disabilities and other complex needs across hospitals, residential services, schools and foster care.
Support and care provision for Adults
Our Adult Services support people with:
• learning disabilities
• mental illness
• acquired brain injury
• autistic spectrum disorder
• one or more physical impairments
Education, care and specialist support for children
Our Children's services - recognised for their expertise - cover assessment, residential care, education and foster care. We specialise in supporting children and young people with very complex needs, including those with challenging or offending behaviours and young people with emotional and behavioural disorders.
CareTech has pioneered outcomes and progression along the care pathway including transition services for young people leaving care and for adults who are making the move into their home after an admission in residential setting.
CareTech's subsidiary - Smartbox - are pioneering innovative assistive technology, empowering communication and enabling enhanced levels of independence for service users. Through our subsidiaries Purple and EnableAll, we strive to create equality and challenge the narrative around disability and inclusion.
CareTech is committed to a long-term, sustainable approach to business, underpinned by the CARE4 responsible business strategy comprised of four pillars:
• Planet
• People
• Innovation
• Community
4. Our Divisions
Through our divisions, we have the expertise and strive to deliver Extraordinary Days, Every Day for adults, young people and children with:
• Mental Health
• Deafness
• Learning Disability
• Physical Disabilities
• Acquired Brain Injury
• Palliative Care
• Autism & Asperger Syndrome
5. Our Values
• Positive
• Person-Centred
• Friendly
•Empowering
• Innovative
6. Services commissioned by the NHS
Mental Health provision
Uplands Independent Hospital,
Fareham, Surrey
Locked Rehabilitation & transitional flats for people with mental health diagnosis.
Uplands Hospital supports men and women to build their independent living and relapse prevention skills to support their journey back into community living.
The service is registered with the CQC.
The Willows - Specialist Mental Health Hospital, Wisbech, Cambridgeshire
The Willows is a 14-bedded inpatient locked rehabilitation and recovery hospital for men.
The Willows is registered with the Care Quality Commission as an independent hospital to support people detained under The Mental Health Act 1983 (amended 2007), people who are subject to the Deprivation of Liberty Safeguards (DoLS) or informally. The service supports men stepping down from secure or acute mental health services, who require a period of rehabilitation, prior to being discharged to live in the community or supported living provisions.
Learning Disability provision Cedar House Hospital,
Bareham
Specialist Low Secure Hospital and Locked Rehabilitation for men and women with Intellectual Disability or Autism.
Cedar House provides a person-centred service that aims to maximise people's choice, control and independence. The team at Cedar House is trained to promote people's dignity whilst integrating multiple factors in a multidisciplinary formulation, treatment and risk management plans to support discharge into a lower level of security. The approach is built upon our belief that everyone should be supported to lead a confident, inclusive and empowered life.
Coveberry Oldbury - Specialist Locked
Rehabilitation Hospital
Coveberry Oldbury is a registered Locked Rehabilitation Hospital with 13 en-suite bedrooms and two independent flats providing supportive rehabilitation for men with learning difficulties, Autism Spectrum Condition and/or mental health diagnosis. Many of our patients may require detention under the Mental Health Act for forensic risks, Deprivation of Liberty Safeguards to help keep them safe from harm and require a structured and safe community setting.
7. Celebrating Outstanding Services
CareTech provides 159 services that are registered with the CQC, of these 84% are rated Good or Outstanding.
Our Outstanding rated services in 2022-23 are:
The Goodwins, Kent a service for adults with a learning disability
Sherwood Court, Hertfordshire a care home with nursing for people with a mental health or learning disability
Complete Care, Trafford community support to people with complex mental health needs
Hilltop House, Northampton providing care and rehabilitation for individuals with an acquired brain injury
Orchard House, Ashford a specialist service for people with learning and physical disabilities who require nursing or personal care
Redbourne, Lincolnshire a specialist rehabilitation service for men diagnosed with a learning disability or autism
Cunningham House, Northampton providing care and rehabilitation for individuals with an acquired brain injury
8. Participation in Quality Networks
Royal College of Psychiatrists - Quality Network accreditation programmes
The Royal College of Psychiatrists Quality Network accreditation programmes work with mental health services across the UK to assess and improve quality.
They set evidence-based standards across different domains that provide a framework for services to measure themselves against. This is done through a process of regular peer reviews and self - review against service standards to promote quality.
Quality Network for Learning Disabilities
Cedars Hospital and Coveberry are now registered with Quality Network for Learning Disabilities.
Quality Network for Rehabilitation Services
The Willows and Uplands services are registered with the Quality Network for Rehabilitation Services.
Ratings for our NHS funded Services
The two services with a previous inadequate rating have been assessed by the CQC in the last year as Requires Improvement and we continue our quality improvement programme to improve these ratings to Good or Outstanding.
For services currently rated as Requires Improvement, we have a specialist quality improvement team supporting the Registered Manager and the operational team to achieve sustained improvements and a Good CQC rating.
CQC Inspections 1st April 2022 to 31st March 2023
Service Inspection Date Publication Date Current Rating Previous Rating Beech Care 10/03/2023 28/04/2023 Good Good Whitecliffs Lodge 20/03/2023 28/04/2023 Inadequate Good Dove Bungalows Residential (Selborne) 05/04/2023 27/04/2023 Good Good Cambian Dilston College 17/02/2023 24/04/2023 Good Requires Improvement Cedar House 08/11/2022 27/02/2023 Requires Improvement Inadequate Cambian Wing College - Southwood Avenue 17/01/2023 25/02/2023 Good Good Russell Lane 31/01/2023 24/02/2023 Good Good Roborough 06/12/2022 26/01/2023 Requires Improvement Inadequate Lyndhurst 07/12/2022 26/01/2023 Good Good Erdington (Oval) & Gateway (Minstead House) 13/10/2022 18/01/2023 Requires Improvement Good Uplands 19/10/2022 17/01/2023 Requires Improvement Inadequate Woodcote Grove 08/12/2022 12/01/2023 Good Good Leigham Lodge 22/11/2022 31/12/2022 Good Good Rockville House Supported Living (Selborne) 21/11/2022 16/12/2022 Good Requires Improvement New Street North 15/09/2022 15/11/2022 Good Good Garrads Road 07/09/2023 19/10/2023 Good Good Beech Care 26/07/2022 08/10/2022 Inadequate Good Kimberley House 26/07/2022 30/09/2022 Good First Inspection Roborough 26/05/2022 19/08/2022 Inadequate Requires Improvement Yewdale 20/06/2022 22/07/2022 Good Requires Improvement Ashview House 13/06/2022 21/07/2022 Requires Improvement Requires Improvement Vosse Court 31/05/2022 24/06/2022 Good Good Tiverton Drive (Selborne) 19/04/2022 17/05/2022 Good Good Church Lane 04/04/2022 04/05/2022 Good Requires Improvement Bethany House 11/11/2022 10/01/2023 Requires Improvement Requires Improvement Complete Care & Enablement Trafford 01/06/2022 29/09/2022 Outstanding Outstanding South East DCA 05/04/2022 22/05/2022 Good Good Redbourne 03/05/2022 24/08/2022 Outstanding Outstanding Oakwood 07/09/2022 21/10/2022 Good First Inspection Oldbury Birmingham 21/06/2022 16/01/2023 Requires Improvement Good
9. Progress on Quality Objectives - 2022/2023
Quality Objective 1 - Quality Strategy, Assurance & Improvement Framework
The year has seen implementation of governance objectives and measures agreed and aligned with the CQC Well-Led expectations. This has included a work programme to incorporate Well- Led expectations into the Company Corporate Social Responsibility plan and regular engagement with a range of managers in developing short focused webinar sessions on key topics, such as what registration means for managers and a service. The management buyout of the Group in the autumn of 2022 also presented an opportunity to review and reaffirm the quality governance arrangements from the corporate body, through each level of responsibility across the Group.
The governance and assurance tools embedded in the organisation have been reviewed and updated to reflect the business year's quality objectives and corporate performance scorecard.
Quality Objective 2 - Clinical Governance Framework
In August 2022, CareTech recognised the challenges and opportunities presented by the Care Quality Commission's publication of its new inspection framework. The announcement of a single assessment framework for all regulated health and social care services in England opened up the possibility of a common approach to care governance across the organisation. Responding to the findings from inspections of services resulting in a Requires Improvement or Inadequate ratings the divisional Senior Leadership Team identified a shortfall in good governance (Regulation 17) as the dominant theme. These problems linked directly to the safety of services. Many of the failings identified under the Safe Key Line of Enquiry by the CQC had causes in a lack of management oversight and robust systems of reporting, reviewing and learning lessons from incidents.
Very positive practices in these areas were found elsewhere in the services rated Good or Outstanding by the CQC in the same period. The organisation recognised that it was lacking a governance framework to define common standards and communicate lessons learnt to share best practice. The objective for a newly appointed Head of Governance for the Adult and Specialist services was to develop a new governance framework that could be used across the whole portfolio and meet the demands of both internal and external drivers. The scope of services involved ranged from a low secure hospital to supported living services.
Firm foundations for the new system were set out in a commitment to deliver three Brilliant Basics at every service.
These were:
1. A monthly meeting with users of the service to review their care needs and views,
2. A meeting with staff to share experiences and lessons learnt
3. A monthly governance review led by local managers to consider the discussions and actions from the staff and service user meetings alongside incident data, reviews and feedback to develop and update the local service development plan.
Brilliant Basics
The agenda for the governance review was designed to pull through feedback from service users and staff and use local incident data to provide a structured review of care quality and safety issues. Where a service was large or complex enough, a daily morning Huddle meeting was introduced to allow an early review of any incidents and response to developing risks to the quality of care.
Governance reviews were to be held at each level of organisation within Adult and Specialist services. This meant three levels of meeting, the local service/site level, the divisional level (Specialist and the four Adult divisions) and a group wide clinical governance meeting to integrate learning across the Group.
Clear pathways and a new feedback system were created to escalate themes and concerns to the Clinical Governance Committee and then on to The Board. Once reviewed, the information can cascade back to services through key messages and lessons learnt. This allowed learning to be taken up more widely and provided a focus for common concerns to be addressed through a group wide response.
CareTech Governance Map
Level 4 Care and Quality Committee Level 3 Clinical Governance Committee Level 2 Division Clinical and Quality Governance Meeting Level 1b Governance Review Business Unit / Hospital Level 1a Governance Review Unit / Service / Ward Team Huddle Data informed by Staff Meeting Staff Supervision Staff Feedback Service User Feedback Service User Engagement Stakeholder Engagement
To ensure consistency, standard agendas were created to support each level and type of meeting. Expected inputs and outputs from each type and level of meeting were defined in their terms of reference. All agendas were aligned so that any items escalated could be aligned to the agenda of the next level of meeting.
All these meetings are part of a four-week cycle reporting finally into a sub-committee of the Group Board.
Four Week Governance Cycle
As well as producing minutes and an action plan each level of governance meeting produces a bulletin highlighting Five Key Messages detailing learning and actions. These are circulated widely and provide a response to items teams teams have escalated to a higher level each month.
Week 1
• Data circulated for previous months KPI, DyLOS, Staffing and Training reports
• Level 1 local service meeting
Week 2
• Level 2 Divisional Governance Meetings
Week 3
• Level 3 Clinical Governance Meeting
Week 4
• Level 4 Board Sub-Committee
• Local Staff Community Meetings
• Lessons Learned Bulletin
Incident reporting and monitoring by the Senior Leadership Team
All services within our Specialist and Adult divisions report weekly into two central reporting systems. DYLoS (our Dynamic Line of Sight) system ensures we monitor and manage risk across every service to improve the quality of care, management performance and staffing. The system has components completed by the Performance Director and our Compliance and Regulation team. This system provides assurance that reviews of local actions plans and task associated with our Operation Orderly management systems have been completed.
Our KPI report is focused on some key indicators of site safety such as incidents, accidents and safeguarding concerns. The submissions can be viewed as a Statistical Process Control chart (example below) to allow easy identification and tracking of any trends. Each week's report is reviewed by our Governance Team to identify any outlying results where services are reporting significantly more events than predicted.
A query is then raised to the local and performance manager for assurance and to enquire if any additional support is needed.
The Senior Leadership Team reviews a report on all 'outliers' for the week and the assurance offered as part of our early warning system to identify services at risk. If the assurance offered is insufficient or there is another significant trigger (such as absence of a manager or unexpected death) reported, the Senior Leadership Team asks an independent manager to urgently visit the service and complete our 15-point safety checklist.
Senior managers are also encouraged to be visible at the services and regularly visit the services they manage to provides additional assurance and keep managers in touch. Each visit aims to include some direct discussion with people using the service about their experience of care. This provides a safeguard against the development of any closed cultures of care in services which are geographically remote.
Peer review
In the last year, we have introduced a programme of peer reviews where members of the team from one service visit another to observe, assess and support through constructive feedback. These visits also provide opportunities to share best practice and enable services in geographically isolated areas to be part of a supportive peer network within the wider Group. This provides additional first line assurance from our operational teams.
Supporting sub-committees of the clinical governance meeting
Four meetings have been set up to allow a regular deep dive into a particular subject relating to safe care. Each meeting is held at least quarterly and provides a report to the Clinical Governance Meeting for information and action.
Positive Behaviour Practitioner Group
This group meets quarterly and reviews incidents of the use of physical intervention across services. All incidents where there was harm, took place on the floor (supine and prone holds) and lasted longer than 10 minutes are reviewed for potential learning. The group is made of the Positive Behaviour Practitioners, trainers and CareTech's National Learning and Development team. Learning informs the Group's Training Needs Analysis. The group has also developed a corporate pledge that will ensure practice is benchmarked against Restraint Reduction Network's standards.
Mental Health Act & Mental Capacity Act Committee
This committee is responsible for ensuring the organisation is working within the legal requirements of the amended Mental Health Act (1983) and Mental Capacity Act 2005. It receives audits and reports on the operation of the Acts and evidence that the organisation is working within the guiding principles of the Acts set out in their Codes of Practice and the Deprivation of Liberty Safeguards (DoLS) requirements.
Medicines Safety Group
This group meets quarterly. Its role is to provide assurance that medicines are used safely across the organisation. That means identifying, reporting and escalating as necessary areas of risk associated with medicines. Any reports of harm associated with medicines are followed up centrally, alongside reports from our external pharmacy reviews and internal audits to learn lessons to improve medicines safety. It also follows up on group responses to alerts from external agencies, including NHS Litigation Authority (NHSLA), Medicines and Healthcare Products Regulatory Agency (MHRA), National Institute of Clinical Excellence (NICE), NHS Improvement, National Reporting and Learning System and Department of Health.
Physical Health Oversight Group
The role of this meeting is to ensure that systems and processes are in place across all services to promote and protect the physical health and well-being of all the people we support. The group is alert to new national guidance, developing best practice and ensuring CareTech's policies and procedures are revised responsively. It has oversight and monitors the training needs and competencies required to maintain good physical health amongst the people our services support.
Care, Quality and Governance Framework
Rapid Improvement - Safety First, Safety Always
Quality Improvement Plan
Culture Change Programme
Quality Objective 3 - Open & Learning Organisation
Our Learning Approach : Everyone, Everywhere, Everyday
Everyone in the organisation can learn and offer learning from their experience of care or from our service users' experience of being supported by one of our services.
A 'lesson' is a piece of knowledge, and/or an action that needs to be taken in order to improve the quality of care. These lessons can have positive impacts on safety, responsiveness and the service user's experience of care.
These lessons naturally arise through the process of care delivery and our governance systems.
Every day is a good day to improve practice and some lessons will be learned and implemented immediately. Our governance structures ensure there is a monthly cycle of meetings and a lesson learnt at a local level can find its way to the Board and then cascaded to all other services within that cycle. Urgent learning, such as a medicines alert, can be communicated more quickly.
At the service user, service, patient and ward level:
• We learn each day on the job through debriefs, clinical supervisions and reflective practice
• We learn together through lessons shared and discussed at handovers, huddles, team meetings,
supervision and service level governance meetings.
• We learn from what others think about us. We learn lessons from Safeguarding, Complaints and Compliments.
This may be within a specific lesson learned folder or using the trackers within the SDP. We should be able to triangulate evidence of lessons learned, so if identified through a safeguarding alert, it is evident on the tracker, on the staff meeting minutes, in a communication book or an individual's supervision.
At the locality, region and hospital level:
We learn from others through peer reviews and the sharing of best practice during visits.
Our governance meetings are focused on learning and improving quality, capturing the key lessons and feeding them back as 'Key Messages' to the divisional governance meeting. Through the analysis of data across services we identify themes and trends highlighting both areas of concern and safe practice.
We share immediate learning through the Performance Directors and Locality Managers.
At the governance level:
At any time, an organisational alert can be created in response to any external or internal risks.
We close the loop on a learning incident at our Clinical Governance Committee which reviews safety and performance across all services. Lessons learnt at that meeting or lessons escalated from divisions and sites are pulled together into Five Key Messages each month that are shared with all services.
CareTech strives to be a learning organisation where people continually expand their capacity to improve.
It means having systems in place to get feedback about the services we provide and have a loop which uses this feedback to improve what we do. We treat complaints seriously and use them as an opportunity to improve. CareTech also invests in the training and development of our staff, giving them the skills and time to reflect and learn.
Good communication is central to being able to learn lessons and then share them.
We are working to improve our structures for reliably sharing information at all levels of the organisation.
At the service user, service, patient and ward level:
We share information each day on the job though debriefs, clinical supervision and reflective practice.
Handovers and Huddles:
Between each shift there is a written handover and verbal discussion to support the reporting of risk and any new information about care. On bigger sites we hold daily Huddles to talk through incidents and plan staffing to stay responsive to changes in the needs of the people we care for.
Team meetings:
Local learning from investigations and a review of trends across a month are discussed with learning identified. Staff share their experiences and insights into how we can improve our services. Their views are considered at the local governance review.
Supervision:
Staff have one to one time with a supervisor to review their experiences and learn of any new approaches and actions from lessons learned.
Nurse meetings and staff engagement meetings:
In our larger services we organise meetings for professional groups and all staff.
Communication Boards:
In between meetings we keep key messages available to all staff and visitors using Communication Boards. Where we can, we keep people using the service up to date with any progress in relation to any concerns through a You Said/We Did board.
At the locality, region and hospital level:
Locality Meetings: Locality managers meet regularly within their division and nationally to ensure best practice is shared across the business.
At the Governance level:
FLEX: Through our active monitoring of incidents identify key issues to address that affect the safety and care of those who receive our services. If staff need an urgent update on a subject, our Focused Learning Experience (FLEX) Sessions can be organised, to quickly to update staff knowledge or skills. Delivered by Teams sessions are accessible to night and day workers and are the most direct way to involve staff in learning and improving the quality of care.
Five Key Messages Bulletin: Our Specialist Division's and Clinical Governance meeting for Adults each produce a Five Key Messages bulletin each month. Circulated to all managers to share with staff this is a regular update on progress and developments across our services with lessons and actions to share and implement.
Organisational alerts: Sometimes we have to respond to external events and share very quickly lessons and actions resulting from learning within the health and social care system.
Quality Objective 4 - Safety
In the last year the company has appointed a group Director of Safeguarding to lead the development of our safeguarding work. They have conducted a Group wide safeguarding review and identified areas of good practice as well as areas requiring improvement. They have developed and delivered safeguarding training at executive level and bespoke safeguarding training to divisions to enhance knowledge, skill and expertise.
"I have dedicated my life to nursing and every day I try to make a difference to the lives of those I have the honour to nurse. I do what I love because I love what I do."
A nurse working in one of our services
Quality Objective 5 - Corporate Risk Management
Each division has a specific risk register and an agreed escalation and review process. Divisions are responsible for the RAG rating of division specific key risks. Several corporate support functions such as Information Governance and Health and Safety introduced a risk assurance process. Health and Safety assurance and management processes were brought in-house in January 2023 to support better alignment of quality KPI's and prioritisation of key quality metrics to the challenges faced in different divisions.
10. How we monitor our services
The key to high quality care is the consistent delivery of key activities that then result in good outcomes. These can be measured in the following way:
• Consistent reporting of safety metrics:
Staffing data
Incidents, overdue datix
Safeguardings
Restrictive practices – restraints, Rapid Tranquilisation, Seclusions, LTS, LRP logs
Duty of Candour
Ligature audits and plans for communication across the teams IPC data
• Consistent reporting of quality metrics:
Person-centred outcome measures
Care plan audits, review of activities and therapies offered
• Clinical Supervision rates
• Training KPIs
• Service user & Carer Feedback Ongoing and point in time
• Environmental and Cleanliness Audits
• Estates and facilities DYLOS data and red flags
• Quality Inspection(C&R) metrics- especially red flags that are the absolute fundamentals
• Lessons learned
11. What our patients say about us
We believe that a person-centred, integrated approach is fundamental when it comes to delivering high-quality care for all of those we support.
Our staff work closely with the people we support to meet the needs of the individual and adapt the approach as they develop resilience, confidence and self-reliance.
A female resident, Lizzy* (name changed to protect the patient's identity), aged 59 has a long history of mental health illnesses as well as physical restrictions caused by congenital abnormalities.
Lizzy is an intelligent and articulate 59 year old with a great sense of humour. She was admitted to Uplands Hospital due to her Obsessive-Compulsive Disorder (OCD) which was impacting on her abilities to manage activities of daily living and restricting her ability to lead a full and meaningful life.
From the age of 22 Lizzy has required multiple hospital admissions including specialist OCD facilities. Her OCD has dominated her adult life although it has become clear, during her time at Uplands, that there were signs of her condition earlier in her teen years. Lizzy’s OCD causes her to have ritualistic behaviours, obsessive compulsive thoughts and actions and she struggles to cope with everyday tasks. Lizzy becomes distressed and rapidly disengages from what she is trying to do.
The team at Uplands were able to identify that Lizzy had not made progress with previous psychoeducation sessions as she was unable to relate this to her own difficulties. It was clear to the Uplands team that a different therapeutic approach was needed.
The Uplands team have been supporting Lizzy in many ways including weekly sessions reflecting on her difficult thoughts, feelings and emotions focusing on behaviours and gradual exposure. This is helping Lizzy to tolerate and manage any distress with a focus on influencing her emotions. At Uplands patients like Lizzy have Positive Behavioural Support (PBS) plans which are person centred with the objective of empowering patients, reducing symptoms and improving communication. This approach has resulted in significant, positive changes to Lizzy’s wellbeing, symptom control and communication. For example, in the past Lizzy did not engage with personal hygiene routines. Now Lizzy is having a shower every week which is a positive change and demonstrates that PBSs can improve people’s quality of life and lead to improved clinical outcomes.
It is likely that Lizzy will stay at Uplands as an inpatient until a point in time when she is able to be supported through to the next stage of her journey. The Uplands team will continue to work with Lizzy ensuring that she is able to build on her progress and eventually able to lead as independent a life as possible in the future
Models of Care
A service that has a written model of care with clearly defined vision and goals is likely to benefit from better clinical outcomes and aligned way of working. Our hospitals have Models of Care founded upon a person-centred approach to psychiatric treatment. They are specifically designed according to each clinical services specialities.
Hospitals for people with learning disability and autism
Oldbury and Cedar House hospitals provide care and treatment for adults with learning disability and autism. The Model of Care offers pathways for people whose behaviour may challenge in mainstream services and for people with forensic or traumatic personal histories.
Staff teams are multidisciplinary and treatments are adjusted to meet the needs of each individual patient.
Clinical outcomes include:
• Quality of life measures
• Reduction in challenging behaviour and risk
• Increased community integration
Hospitals for people with mental health needs
Our mental health hospitals, Uplands and The Willows, personalise care and treatment to stabilise and reduce symptoms of major mental illness and promote rehabilitation prior to discharge to the community.
The care is multidisciplinary and the treatment pathway is designed to protect patient safety, improve mental health and independent living skills. Community access and integration is important for increasing self-esteem and social skills. Occupational Therapy, Psychology and GP services add to psychiatric and nursing care to provide a whole person approach to health and wellbeing.
We use outcome measures to assess reduction in symptoms of major mental illness, acquisition or development of independent living skills and physical health. We use patient rated measures to look for progress in well-being and quality of life.
Support for people with acquired brain injury and neurorehabilitation needs
All Hallows and Oakleaf neurorehabilitation services' Model of Care is designed to restore function after brain injury in a short period of residential treatment. Care pathways for brain injury, stroke, palliative and respite care is delivered by an interdisciplinary team. Outcomes are measured through restoration of function and the majority of residents are discharged to their own homes
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12. Quality of Life Measure
Summary MANS outcomes for Cedar House April 2023
I feel like I am being everything
I can be
I feel like I accept who I am I feel like life is worthwhile
I feel I respect other people I feel other people respect me I am achieving what I want to
I feel confident I feel good about myself
I feel happy about boyfriends or
girlfriends
I feel accepted by other people
I can make and keep friends
I get on with the people I know well (e.g. my family, the staff who
support me)
I am happy with my health
I am happy with where I live
I am happy with how I spend my time (e.g. jobs, college)
I feel like deliberately hurting myself,
or trying to kill myself...
I feel like hurting other people...
Other people try to hurt me...
I feel my basic needs, such as the food I eat, how I sleep and keeping warm are being
met...
0 2 4 6 8 10 12
Hardly ever
Not very often
About medium
Most of the time
Nearly always
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WHOQOL summary Cedar House April 2023
The WHOQOL (World Health Organisation) is a patient rated quality of life measure. Findings:
• 17 patients at Cedar House Hospital completed the survey.
Results show that:
• Patients are mostly content.
• Some feel that things could be improved in the areas of:
• Personal energy.
• Better relationships.
• Better living conditions out of hospital.
not at all
a little
some
mostly
completely
Do you think you have enough energy?
0 1 2 3 4 5 6
very bad
bad
about medium
good
very good
Overall, do you feel your life is...
0 1 2 3 4 5 6
How happy are you with your health?
very unhappy
unhappy
about medium
happy
very happy
Are you happy with how well you can do things for yourself? (daily living activities)
0 1 2 3 4 5 6 7 8
How happy are you with your relationships with other people?
very unhappy
unhappy
about medium
happy
very happy
0 1 2 3 4 5 6 7
very unhappy
unhappy
about medium
happy
very happy
0 1 2 3 4 5 6 7
28 29
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13. Our People, Our Greatest Asset
The Health and Social Care sector continues to experience significant pressures on staffing and CareTech is not immune to these challenges.
We are committed to building a sustainable workforce for services across our portfolio and to make a positive difference to the lives of the people we support.
Staffing and Resources
We operate a clear organisation and management structure with defined accountabilities/ responsibilities for all those who deliver services. Our established local infrastructures includes access to centralised functions and a highly visible management presence, regularly visiting services/attending team meetings/providing immediate access to support/advice to staff, supported individuals, healthcare professionals and commissioners.
Our on-call system ensures 24/7 management support with knowledge/experience to respond to emergencies as they arise.
Our team are invested in meeting their local community's needs and equip their staff teams to deal with what can be frequent/high impact situations in our more complex services, including careful recruitment and forward thinking, proactive management that ensures team bonding and positive attitudes every day.
Flexible and Responsive
Provision of a highly skilled and motivated staff team with the right values is key to ongoing service delivery. We expect (and measure) that managers/staff are skilled in:
• Communication - being able to provide clear information to all stakeholders, be accessible, listen to problems and set a clear direction.
• Work in a person-centred way - involving
service users/their families/staff in decisions, ensuring their commitment/motivation.
• Meeting targets and standards - promoting
high standards to meet both regulatory/ contractual requirements. This ensures viability/security of the service, giving continuity to service users.
• Building relationships - with all agencies/
individuals who can provide opportunities to service users, enabling them to be socially included and have truly personalised care/ support.
Commitment to Staff
Our family ethos means we create effective teams, with retention figures higher than the sector average, means those in our care benefit from receiving support from people that really know and understand them and walk by their side through their whole journey with us:
• Our commitment to training and mentoring with wrap-around support from internal specialists and initiatives such as our Lead to Succeed and new Management Progression Programmes means staff can fulfil and exceed their own career aspirations and CareTech develops managers of the future, benefiting the whole care industry. Complex needs staff are expected to have advanced training/ qualifications, enabling organic growth whilst ensuring resilience via strong operational support/leadership. As a result, support staff are encouraged to move towards level 5 Lead to Succeed/Outstanding Care and managers continuous development includes options including L5 Positive Behavioural Support Practitioner.
"From myself I love being able to feel like I make a difference even if by only small actions such as supporting with anxiety around medical interventions, being able to support them to be able to tolerate things such as having blood pressure taken, vaccinations, blood tests etc. I feel that I have been given lots of support throughout my career and I am really grateful to the support I have had to get where I am now. I feel valued and able to voice and implement changes."
A member of staff
"I enjoy being a nurse because of the fulfilment l get within myself for serving and contributing to the society."
A member of staff
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14. Investing in our Learning & Development Programmes
e-Learning
Face to Face Sessions
Virtual Sessions
Leadership and Management Training
Mentoring
Coaching 1:1 Tuition Advice Guidance Distance
MYRUS
In-house Learning Management System
Providing opportunities to learn skills and confidence
At CareTech, we understand that learning is a lifelong process. By providing opportunities for impactful and effective learning experiences, we are committed to increasing employee engagement, retention and promote professional growth and improved resident experience.
CareTech's National Centre for Learning and Development (NCLD) assesses the need of the services, residents, staff, the business and relevant regulatory requirements to then plan, design and deliver training programmes to 12,000 staff.
Their philosophy is built on the Centre for Creative Leadership model of the 70-20-10 Model for Learning and Development. This model describes the optimal sources of learning where 70% of knowledge is obtained from job-related experiences, 20% from interactions with others, and 10% from formal educational opportunities.
NCLD team delivers over 350,000 learning interactions across the Group each year. This includes face-to-face, virtual, eLearning and action learning where teams come together to resolve problems, develop practical solutions, agree their implementation and relevant measurements to assess their impact.
Time to recruit
Over the last year, we have reduced the time to hire from seven weeks to five weeks. We are confident that we will hit our target to reduce this to four weeks by the end of the next reporting year. This has been driven by recruiting additional resources in our recruitment teams, including introducing the new Engagement Officer roles. We have also invested in our Applicant Tracking System (ATS) digital recruitment tool, that provides a significantly more streamlined and efficient process for applicants and those involved in recruitment internally. The ATS
system, which is now fully operational across all business units, also provides us with far more robust data around our people, supporting work around diversity and similar key people priorities.
Valuing the diversity of our staff
Valuing the full diversity of our staff remains a key priority. We have been developing a new Equity, Diversity and Inclusion (EDI) Strategy, working with colleagues to ensure that this vital issue is addressed across all elements of our business. In March this year, CareTech were awarded Disability Confident Leadership status. In order to achieve this, CareTech put in place inclusive policies and practices that are thread throughout the business to provide equal and inclusive opportunities for all.
Our Purple business is a leading player in promoting equality and opportunity for all. Allied to our commitment to EDI, we have developed our Alternative Recruitment Pathways scheme. Working with a range of partners, we are seeking to develop recruitment pathways to social care careers for those under-represented in the sector but also who face significant challenges in securing employment more generally.
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CARETECH Quality Account 2022/2023 CARETECH Quality Account 2022/2023
Learning & Development Programmes
We continued to build upon our new Management Development Programme covering the key leadership pillars of:
• Leading Self
• Leading Others
• Leading Collaboratively
• Leading for the Future
A key element of the programme is the opportunity for leaders from across all our divisions to work together, share stories, best practice and learn together. Building on the Management Development Programme, the Leaders Coaching Programme was developed to provide middle managers with coaching skills to support front line leaders in their performance development. Together, the programmes are promoting changes in thinking around how leaders act and work, supporting our business values and changing the culture of leadership across the business from transactional to transformational.
8th Annual CareTech
Care Awards
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15. Quality Objectives for 2023/2024
The CareTech vision of Extraordinary Days, Every Day is expression of a "Quality First" ethos of care. The organisation has set quality objectives to strive to continuously improve the services we provide.
Quality Objectives for 2023/2024 are:
1. Ensuring a Safety-First approach in all that we do.
2. Focusing on the accuracy and ability for all staff to recognise, respond to, record and report risk appropriately and in a timely manner.
3. Further developing a learning culture across the organisation.
Quality Objective 1 - Ensuring a Safety-First Approach
Safety is an absolute priority across the organisation, with an ambition to provide the best and safest care. Over the last year, CareTech has developed systems and processes, drawing on insights from multiple sources internally and externally to improve the understanding of safety across services.
These are reviewed through the governance framework.
Our objective in the next year is to embed these processes into the routine practice of all our care services.
There will be a focus on ensuring staff have been equipped with the skills and opportunities to improve safety, across the whole system. In the last year a quality improvement programme has focused on ensuring that the mandatory training available is appropriately prioritised, allocated and monitored. In the next year we will review the uptake of training and explore how to demonstrate staff competencies in key clinical skills.
Additional training activities will be developed responsively as part of the FLEX (Focused Learning Experience) sessions, run across day and night to be accessible to all staff, to deliver immediate learning arising from incidents in real time.
Our new monitoring and assurance frameworks will be consolidated as we refine our understanding of the risks to safe care. We aim to increase manager and senior leader visibility based on the 15 steps tool to ensure staff feel safe within the work environment.
This also includes reviews of recording and specific interventions when services are deemed at risk to support care stabilisation and improvement.
There has been a focus on improvement programmes to deliver effective and sustainable change to deliver a safety culture.
Three of our current Adult and Specialist Services Key Performance Indicators adopted in November 2022 relate directly to safety.
Reducing restrictive practice
Purpose: CareTech is committed to its membership of the Restraint Reduction Network, the use of least restrictive practices and meeting their standards.
Measure: Restraints are reducing as indexed against number of restraints / people we care for per division by 5%.
How we measure: Establish baseline and set target for reduction. Data is available from DATIX and KPI reports. Agreed to compile a monthly report, with support of NCLD.
Frequency: Monthly report from all services.
Review: Monthly Clinical Governance meeting and Board Sub-Committee.
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Safeguarding
The number of safeguarding concerns reported as a result of alleged staff abuse are routinely monitored, trends are analysed for underlying themes. The line of travel is assessed and themes acted on to inform training, value-based recruitment and managerial awareness of closed culture risks.
Purpose: CareTech is committed to reducing the risk of harm from staff abuse, of those we care for. A focus on learning from safeguarding concerns involving staff actions, will help staff to model positive behaviours.
Measure: Extract reason from CQC Statutory notification when a safeguarding concern is raised.
How we measure: Monthly summary of safeguarding notifications sent to CQC sent to and analysed by Compliance and Regulation Team.
Frequency: Monthly report from all services.
Review: Monthly Safeguarding, Clinical Governance meeting and Board Sub-Committee.
Safe Administration of Medicines
Purpose: CareTech is committed to reducing the number of medication errors and resultant harm. We keep people using our services safe, by reporting medication errors and by learning from them to improve practice.
Measure: Reduce the number of medication errors by 5%, for each division.
How we measure: Medication errors are reported weekly in the KPI report (Column AK) and errors resulting in further action (Column AL). System is used universally and monthly reporting is available.
Review: Monthly Clinical Governance meeting and Board Sub-Committee, with a focus on errors requiring follow up. Information available at a local level for site/locality review.
Quality Objective 2 - Focus on the accuracy and ability for all staff to recognise, respond to, record and report risk appropriately and in a timely manner
Given the nature of services, it is accepted that risk cannot be eliminated, hence there has been a focus on how rigorously risk can be assessed, managed or mitigated. Our key aim is to support staff to identify and assess risk, recognising the balance needed between meeting the desires of people to do everyday activities, with the duty of care the organisation owes to them.
The focus in 2023/2024 will be on embedding the following principles around understanding risk:
Identification, assessment and management of risk should promote the independence and social inclusion, of the individual receiving our support.
Risks change as circumstances change and should be reviewed on a regular basis. Information used and recorded should be as comprehensive and as accurate as possible. When risk is identified, this carries a duty to do something about it.
Timely and precise reporting allows for responsive sharing and promotes wider learning and the ability for organisational review.
One of our Adult and Specialist Service KPIs sets measures reporting timeliness in reporting to ensure any new risks are quickly understood and acted upon.
Responding to and learning from incidents
Purpose: CareTech is committed to learning from incidents and making improvements when required to reduce future risk. For greatest impact, the early review and identification of immediate lessons learned and a responsive investigation and sharing of findings are required.
Measure: Incidents are reviewed in a timely manner (within 48 hours) and investigations closed within 28 days.
How we measure: Open incidents can be monitored from our electronic incident reporting systems. Services using paper incidents; reports will be reviewed as part of a sampling effort.
Frequency: Monthly report from all services.
Review: Monthly Clinical Governance meeting and Board Sub-Committee.
NB DATIX is easily tracked; other systems will require regular audit that incidents are reviewed, triaged in 24 hours and investigations, where required, completed in one month.
In Adult Services, all incidents are escalated to Managing Director and reviewed 1:1 with Care Managers. We are developing an evidence trail of this process. All services should hold an incident accident log on site, as part of Operation Orderly.
Quality Objective 3 - Developing a Learning Culture Across the Organisation
There is an agreed approach to developing a learning culture promoting that learning is for Everyone, Everywhere, Everyday. The organisation will continue to promote the understanding of what a "lesson" is, and how important learning and sharing is in providing care that is safe and effective.
The rollout of the governance framework emphasising the importance of "Brilliant Basics" across the organisation will make routine the capture of service user voice and staff voices and reviewing data to understand themes and trends to develop sources of and opportunities for learning.
We will report on progress in all these areas in our next Quality Account for 2023/2024.
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16. Community Engagement
'100 Voices', Smartbox assistive technology project supports advancements in choice, control, independence and opportunities available to people we support.
Purple Tuesday, founded by one of CareTech's group of companies, inspires organisations of all sizes/sectors, offering free tools/information/guidance to implement solutions to improve the disabled customers' experience.
Partnerships through CareTech's Charitable Foundation, such as a grant and working with RNIB to increase awareness and understanding of the impact on sight loss for people with learning disabilities.
Although a national provider, our services are created locally through relationships that enable collaboration in order to develop support solutions, maximise assets and strengthen opportunities for customers, communities and providers.
External collaboration
CareTech's National Centre for Learning and Development (NCLD) are learning and development innovators committed to advancing the skills and expertise of the social care workforce.
External engagement enables the NCLD team to put practical solutions in front of policymakers and influence the development of new policies and procedures for the sector. The team often engages with service users who share their lived experiences and the impact of decisions of others.
NCLD has worked with a range of sector partners, such as Skills for Care, on workforce development solutions and high-profile projects, including:
• A Question of Care
• Situation Judgement Test
• Profiles4Care (a trial of psychometric testing to recruit to specific roles)
• Care Certificate
• Development of Care Act Resources
NCLD is actively working with the government and policymakers to share a provider perspective of the impact of government workforce strategies. Recent policies include T-Levels, Safeguarding policies, Public Health and Healthcare Apprenticeship standards development.
Staff sit on many forums, ensuring we remain up-to-date with practices/research whilst working within trailblazer groups to set standards across health and social care and as technical panel members for the health and science route way.
Care Home Open Week
We believe firmly that our care services should be at the heart of the local communities in which they are based. We are keen to showcase our capabilities and resilience, but most of all highlight the life changing impact that social care has on some of the most vulnerable people in our society.
This year, we significantly increased our engagement in Care Home Open Week to enable us to welcome local communities and community leaders to learn more about our services, those we support - and our brilliant staff!
Care Home Open Week is a national initiative organised by Championing Social Care, which this year ran from 27th June - 3rd July 2022. Care Home Open Week is a brilliant opportunity for care homes to reach out, connect and celebrate the care delivered in social care with their local and wider community.
One example of this year's involvement was the visit by Mohammed Yasin MP and Councillor Colleen Atkin to Byron Court and Chaucer Court care homes in Bedford. These two homes provide residential care and support for people with learning disabilities. Mr Yasin and Cllr. Atkin met with the residents and support workers in the two homes. The residents shared their journeys and staff members discussed the challenges in the social care sector.
Care Sector Fundraising Ball
Alongside the CareTech Foundation, CareTech was Headline Partner for the third year running of the Care Sector Fundraising Ball. Bringing together over 500 guests from across the sector, the Care Sector Fundraising Ball 2022 was held at the Grosvenor House Hotel, Park Lane in September 2022, raising pledges of over £400,000 for the Alzheimer's Society and the Care Workers' Charity - more than double the proceeds from the previous Ball.
Beyond the funds raised for these two excellent charities, the Ball was designed to be fully accessible for guests with disabilities and also the most sustainable event to date in the care sector.
Whilst every effort was made to eliminate the carbon impact of the event, the Ball team worked with Ecologi (www.ecologi.com) to offset any carbon that couldn't be avoided.
This will be achieved through support of a wind power project in Thailand and the Bahuaja Biodiversity Reserve in Peru. In addition, 550 trees will be planted for each of the guests who attended the Ball in Uganda, Madagascar and Morocco!
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17. Complaints & Compliments
We monitor the number of new and open complaints in order to judge the responsiveness of services to any concerns and learn lessons. These are tracked at a divisional level and there is a central complaints register within the Specialist services division to allow central oversight of progress on responding to a complaint and analysis of themes.
The accompanying Statistical Process Control (SPC) chart evidences the number of complaints received each week since October 22 for the 19 services within the division.
Each ward or clinical area has information available for service users on how to make a complaint. Within our hospital services there is additional information available on the role of the CQC in supporting detained patients in making a complaint. Additional support is also available from the local advocacy services who regularly support patients to raise their concerns. In our learning disability services we make this information available in accessible formats such as Easy Read.
Outside of the formal complaints process users of our services are encouraged to raise concerns and ask questions in the regular community meetings that all our services host. Direct feedback on actions taken in response are communicated directly to our service users often using the 'You said, we did' format.
Services also try to learn from positive feedback in the form of compliments they receive.
NOTES
Specialist New Complaints - Specialist starting 09/10/22
20
18
16
14
12
10
8
6
4
2
0
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CareTech
5th Floor Metropolitan House
3 Darkes Lane Potters Bar Hertfordshire
EN6 1AG Tel: 01707 601800
www.caretech-uk.com