This article was first published in June 2016

For the residents of 16 King’s Road, a residential service for people with learning disabilities in Lee-on-Solent in Hampshire, their games room is their pride and joy, and many happy hours are spent in there in friendly competition.

The games room is a recent addition to 16 King’s Road, which is home to six people aged 22-41. Each resident has a learning disability or autism spectrum disorder and some also have additional complex health needs including epilepsy and diabetes. When Care Management Group (CMG) took over the house, it was a sensory area, but after consultation with the residents it transpired they would prefer it to be a games room.

As it was the residents’ wish, the staff at 16 King’s Road set about making it happen. This is indicative of the philosophy of the care and support that the CMG team provide at the home, which was rated as ‘outstanding’ in its most recent Care Quality Commission (CQC) inspection report – one of only about a dozen learning disability services to receive such an award since the regulator changed its inspection regime in October 2014.

“Service user choice is another really big thing for us and we have lots of interaction about the house and what they would like to see in it,” says Sophie Hare, registered manager at 16 Kings Road. “It’s their house and they should be involved in those kinds of decisions.”

A person-centred approach is fundamental to the care provided at Kings Road. Each individual is assigned a key worker to ensure their needs and preferences are met. The team has a close bond with the individuals they support. The residents use different ways to communicate depending on their personal preferences. These include using picture cards or apps on tablet computers. Listening to what the residents have to say is very important to the team. The CQC’s report highlighted how the service “empowers people to express themselves and be involved in decision making in the home”.

Monthly meetings are held where tenants are encouraged to have their say on decisions affecting the house such as the layout, preferred colours of the walls and where to go on day trips and nights out. The meetings are pictorial-led to help with group engagement and participation. Individual reviews between each person and their care worker are also held every month. The reviews provide a good opportunity to catch up and discuss what individuals would like to do or if there’s anything they need help with.

“We have a diverse team and each staff member has the people they support at the heart of everything they do,” says Hare. “Staff are really flexible and this was another area that the CQC highlighted. We reviewed our shift patterns following feedback we received from service users and their families as part of our Driving Up Quality self-assessment. Staff members now work around the people they support to ensure all their activity needs can be met.”

The residents are involved in other areas of the running of the house. They each have roles within the home such as fire marshalls and carry out their own food shopping – they are encouraged to eat healthily. Residents also assist with recruiting and interviewing potential new members of staff.

“Most of the people we support have their own questions to ask candidates,” says Hare. “Following the interview, we’ll have a chat and make a decision around whether the residents were happy with the responses they got to their individual questions. We have to be quite creative around getting the residents to voice their opinions and make choices as this is not something that comes easy or naturally to them.” Currently, five of 16 Kings Road’s residents are in voluntary employment and the other is in full-time education. Roles include working as a commis chef in a pub, gardening, cleaning and leaflet distribution for local companies. Hare says the voluntary work is beneficial to the residents and the value of the experience is more important to them than receiving any financial reward. Additionally, ASDAN training opportunities will soon be available to the residents to enable them to receive qualifications in areas of interest.

New inspection regime

The new CQC inspection regime, introduced in October 2014, was developed in response to the failings uncovered at the former Winterbourne View hospital in Bristol by a BBC Panorama investigation in May 2011. The regulator acknowledged past failures of inspections in care homes, hospitals and across GP services. These failings were blamed on a lack of specialist inspectors and a model that did not work – namely assessing services based on their regulatory compliance only. The CQC’s new regime represents a significant change around how providers are inspected.

Inspection teams now comprise a CQC inspector, clinical experts and experts by experience – members of the public who have personal experience of a particular area of care. Teams ask five key questions when inspecting: is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

A rating is given for each of the five questions in addition to an overall rating for the service. The four ratings are: outstanding (the service is performing exceptionally well); good (the service is performing well and meeting expectations); requires improvement (the service is not performing well and has been advised how it must improve); and inadequate (the service is performing badly and action has been taken against the person or organisation that runs it). The CQC says in its consultation document that it has ‘zero tolerance’ for services where care is poor.

“Our new inspection and ratings approach is very different and this has many benefits,” says Deborah Ivanova, CQC interim deputy chief inspector for adult social care in the south and London region. “We needed to find a way to get a more in-depth look at what’s going on in services and the five key questions enable us to do that. We are setting the standards of what we expect services to achieve and this encourages providers to improve.

“Although it’s still early days and we haven’t yet completed first ratings on all of the services, the new inspection regime has had a positive impact. Over 40% of services that we have been back to have improved. Although this isn’t a significantly high number, what we have to consider is sometimes parts of a service will improve but not enough overall so the service will still have a ‘requires improvement’ rating until the next time we go back. I think the public really understands the ratings and the need for a fast response towards inadequate services. They are given a short time to improve and then we take action.” Also crucial to the CQC’s new inspection approach is assessing services from a more personal perspective. The teams frequently ask the mum’s test question – is it good enough for my mum and would I be happy placing a loved one in the care of this service? The mum’s test is also a driving force for the team at Kings Road. It is such a central focus point that staff are encouraged to bring in photographs of their loved ones so the principles of the mum’s test are on display.

Achieving an outstanding rating

An important difference for the CQC in ascertaining good and outstanding services is having a consistent management and a service that is well-led, says Ivanova. “What’s really key to whether a service can achieve outstanding is when a registered manager and a provider work well together to set a leadership ethos for all staff to follow. An open culture where staff feel valued and their development is important to the provider is another key difference. One aspect that is really important for services for people with learning disabilities is having strong community links. Outstanding services are those that are active in the community and are seen as positive contributors. For example, being involved in fundraising for a local charity via sponsored walks.”

Most importantly, services must be absolutely focused on individuals and what they want to achieve, says Ivanova. “Person-led services that enable and encourage individuals to develop can make the outstanding rating. However, it’s interesting to note that most good services do this. I think what makes up the exceptional or distinctive characteristic that leads to an outstanding rating is when person-led care is the feature of everything that happens in that service. It’s about the way the service is run, the way decisions are made and it’s about the way the service is organised around its service users.” Ivanova also highlights the importance of having a can-do attitude and striving to provide a consistently great service.

This attitude is visible in the management of 16 King’s Road, and the work never stops to improve the service on offer. “We are so proud to be rated outstanding,” says Hare. “We have action plans in place to keep the outstanding ratings we already have and we would like to add another outstanding category next time. We have made unbelievable progress with one person we support and our work in reducing difficult behaviours has also been incredible. However, the team at Kings Road is only part of the package. We couldn’t do what we do without the support from the company and our clinical teams.”

About the author

Julie Penfold is a freelance journalist.