The CQC requires all new starter home care businesses to submit a Management policy and procedures document.
Below is Quality Home Care policy and procedures for:
assessing and monitoring the quality of your service
identifying and assessing risks to the health, safety and welfare of people who use your service
the maintenance and safe storage of records about service users and staff
obtaining and acting on feedback from service users.
QUALITY MANAGEMENT Policy Quality Assurance (QA) is a systematic and objective management process to ensure that an organisation actually does what it plans to do to the intended standard and also learns how to improve. The overall aim of QA in domiciliary care is to ensure that each customer achieves their desired outcomes for health and wellbeing, through reliably and consistently receiving the right, high quality of service. The Quality Home Care model of care at home has specific objectives and systems in place in order to meet our overall aim which is treating our customers in the way we would wish both ourselves and our relatives to be treated. While the company recognises that there are legal and regulatory requirements to be met and considered, quality assurance is not simply a device to satisfy the requirements of regulatory bodies. It is the tool Quality Home Care uses to ensure delivery of high quality care and to exceed the expectations of regulators (and our customers) or any minimum standards that may be set.
The company believes wholeheartedly in continuous improvement in its services as well as seeking new avenues to expand the business. To do this Quality Home Care will always seek to measure its performance against the benchmarks of good value, reliability and customer satisfaction. Only the customer can decide if the service we provide meets their requirements and needs, in the way that they prefer. Every employee needs to be clear about what is expected of them, what Quality Home Care aims to achieve and what the customer wants us to do. Managers need to make sure that procedures or plans are implemented effectively in practice. Those employed by Quality Home Care will need to feel valued, listened to and enjoy a sense of pride in their employment. Quality Home Care’s emphasis is on assuring quality for our customers, which is critical to their quality of life, safety and well being. The company will always consider ways of how we could do things better, based on our quality monitoring system and the feedback we receive from our customers, staff and other stakeholders. The purpose of QA will be a positive function focusing on promoting improvement as opposed towards a focus on simply finding out what is ‘wrong’. There are several components to quality assurance and the company will address each and all of the various parts as and when appropriate. Reliability and consistency is an important part of the quality measurement if found lacking, needs to be rectified. Similarly, the staff relationship with customers is of paramount importance including how staff conduct themselves generally. Quality Home Care should be accessible to all regardless of age, disability, sex, culture, religion or other preferences and beliefs. The company is committed to promoting and maintaining customer independence and choice and not ‘taking over’ or ‘doing things to’ the customer but with them. These areas should be checked as part of the quality monitoring process - for example, by a series of visits, questionnaires and inspections by senior members of staff. Procedure Quality monitoring and evidence to check customer and service outcomes should be gathered by a number of methods including: Feedback from customers: This includes analysing: • Compliments and suggestions for improvement • Complaints, from any source, whether formal or in passing • Reports from care workers or other professionals involved in a care package • Underlying causes of any untoward incidents • Are they generally content with the service? • What particular aspects of the service do they perceive to be important or valuable and are they content with the service on these important aspects? • How could the service be delivered better? • What additional services would they like to be offered? • Why are customers leaving? • Why did enquirers choose not to buy a service – was this about accessibility? • How could the service better meet the needs of those they represent? Methods for obtaining customer feedback Routinely seeking customer views ranging from informal to more formal, for example: • Asking the question, “How is everything going with our service?” when speaking to a customer on the phone (make sure both the question you asked and the answer are recorded in writing). • A more formal, phone call to each customer at least once a week, to ask the same question, “Just a routine check that everything is ok.” • As part of the regular review process or a procedure where a care manager or supervisor visits each customer once a month, to check satisfaction and perform a ‘mini’ care review. • Other useful routine procedures should following up on departing customers or those who enquired but chose not to take service from you. This may be done by phone or letter and should be done in the spirit of enquiry and desire to improve, not as a hard sell. • A formal annual survey, to check customer satisfaction, to ask a range of questions and gain information on the topics which are of particular importance. The response rate will be improved by including a postage paid response envelope. (See Appendices 1 – 3 for Quality survey customer outcomes and customer survey formats in A4 and leaflet style). Audits An audit is a process of regular checking that something exists and it is useful for monitoring standards which relate to documentation. A key role of the audit is to check that operational procedures have been implemented and demonstrated by the completion of appropriate records (using the correct tools) and so confirm that the actions or procedures have occurred as planned. Simple tools such as checklists can be used to do this. Customer safety and security is key and all staff members must be personally interviewed prior to acceptance onto the training programme and all staff are subject to the necessary recruitment checks. Security of customers is vital and will form part of any risk assessment as well as ongoing quality monitoring. All staff must be trained and competent therefore an analysis of feedback, staff training records and supervision is also an important part of the quality monitoring process. Audits should be completed to check targets are being achieved and company policy and procedure is being complied with in areas such as: • Quality Home Care Model aims and objectives • Recruitment, staff turnover and retention; • Customer care plans and reviews; • Staff supervision and appraisal; • Staff Induction, training and development; • Policies and procedures are up to date; • Incident and accident reporting and recording • Outcomes of regulatory inspections; • Compliments and complaints Periodic reviews (for example three monthly) should take place of incidents and accidents, as well as compliments and complaints received. This should identify any patterns regarding the frequency, nature, source, context and response to such events and what action needs to be taken by the company to address areas for improvement if necessary. Information and reports should be taken periodically to check the business is operating effectively, that targets are being achieved and to monitor the financial management of the company. Observation Some aspects of service can only be satisfactorily assured by actually watching the activity concerned and may be used to confirm that operational records are not being falsified. It is particularly useful where you want to assess how something is done, rather than whether it is done. Observation is therefore essential to assess quality of care worker behaviour, skills or attitudes. It is important that all observations should be carefully recorded eg, by notes on care worker files. Examples of observations include: • Spot checking arrival or departure of care workers • Accompanying care workers on visits to ensure that behaviour towards customers is appropriate and dignity maintained at all times • Watching care workers perform moving and handling tasks to ensure that safe methods and techniques are being used Supervision Supervision, in one-to-one or group meetings, is a two way process for discussion of important practice issues and performance over a period. For QA, it is useful for checking continued understanding of key issues, reinforcing expectations and supporting / planning development for individual workers. Both positive and negative points should always be recorded to the worker’s file. Key issues should be recorded to a central office file so that managers can identify trends and training needs. For example, planned discussion of issues on medication can check that care workers are following procedures, highlight unforeseen issues or reassure and allay any concerns the worker may have. The process will ensure that the competence of workers is checked and any training needs or other actions required to address competence issues are initiated. Review Review is an essential and continuous part of any QA system. The data and information emerging from all the sources described above must be regularly analysed. The critical component of review is that it must be followed by plans for action. Without effective action to correct or improve, the entire QA system will have been a waste of time and money. Many issues which come to the attention of managers, in the course of gathering data, can and should be dealt with by immediate action. The fact of having to take such action is, in itself an important matter to record, as it may be the first occurrence in a series or symptomatic of deeper problems. Examples include: • An individual worker is observed using unsatisfactory moving and handling techniques • An individual worker is found not to have complied with an existing policy or procedure, which otherwise appears to work satisfactorily • Any situation which involves risk to customers or care workers • Review of latest inspection report identifies need to change policy on medication administration Other matters will only emerge as needing attention, or needing action broader than with an individual worker, when they are identified as repeated occurrences or trends. For example: • Repeated observations of poor moving and handling techniques, by a number of care workers, would suggest that arrangements for training need to be changed • Review of feedback from workers may identify a more effective way to record assistance given to service users with medication By reviewing practice based on evidence gathered, improvements to service provision can be made. All results of QA analysis and review, including actions taken or planned, should be recorded within a QA management summary, which will form an important part of evidence for third parties, such as regulators or purchasers. Larger or more long-term actions should be consolidated into a formal improvement plan, which is likely to require adjustment to future business planning, as it may involve significant expenditure. Plans and changes need to be effectively communicated to the staff that will be required to deliver them. Evidence from QA will be a valuable tool to demonstrate the need for change. You will need, in most cases, to ensure effective staff training, to check understanding of what is required and to check what you have planned is actually implemented. Related policies: The effective implementation of the Quality Home Care model and all associated policies and procedures for the company, are relevant to quality assurance policy and procedure. APPENDIX 1 QUALITY SURVEY - CUSTOMER OUTCOMES Quality Home Care Number of questionnaires sent: Date sent: Number of Questionnaires returned: Date of evaluation: Evaluation completed by (Print Name): Signature and Role: Insert total number of responses in relevant areas (in percentages) Outcome Area Yes No No response 1. Have you received an Information guide? 2. Do you have a Quality Home Care Signature book? 3. Do all your Care Workers arrive on time? 4. Are you informed if your Care Worker is going to be late? 5. Are you informed if there is a change in care worker? 6. Do care workers treat you with respect and politeness? 7. Are the tasks carried out properly and professionally? 8. Are all tasks on the care plan completed at each visit? 9. While we always hope to provide a high quality service, would you know how to complain? 10. Is there anything NOT on the agreed care plan which your Care worker regularly carries out? 11. Are you satisfied with the service you receive from Quality Home Care? 12. Summary of feedback regarding concerns or complaints from outcomes: identify and highlight any common themes etc: 13. Summary of customer feedback regarding suggestions/ideas for improvement identify and highlight any common themes etc: Action Plan: By When: By Whom APPENDIX 2 CUSTOMER QUESTIONNAIRE This questionnaire is designed to help us help you. It is important that we know your views. All completed questionnaires will be treated in confidence. It is principally by asking our customer’s that we know whether we are doing a good job or not. In order to improve the quality of the way we deliver your care we would like to ask you to take a few minutes to answer the following questions. If you would like a member of our management team to visit you and help to fill in the form, please feel free to contact us. Your Name: Address: 1. Have you received an Information guide? Yes / No 2. Do you have a Quality Home Care Signature book? Yes / No 3. Do all your Care Workers arrive at the specified time? Yes / No 4. Are you informed if your Care Worker is going to be late? Yes / No 5. Are you informed if there is a change in care worker? Yes / No 6. Are care workers polite and treat you respectfully? Yes / No 7. Are the tasks carried out properly and professionally? Yes / No 8. Are all tasks on the care plan completed at each visit? Yes / No 9. While we always hope to provide a high quality service, would you know how to complain? Yes / No 10. Is there anything NOT on the agreed care plan which your Care worker regularly carries out? Yes / No If ‘yes’ please give details: 11. Are you satisfied with the service you receive from Quality Home Care? Yes / No 12. If ‘no’ please write here any concerns or complaints you have about the service 13. How could we make the service better for you? Would you like a member of the management team to telephone you (or visit your home) to discuss the comments you have made on this form? Yes / No Your signature ……………………………………………..……………… Date ……………….. Thank you for taking the time to complete this form. Please return it to us in the stamped addressed envelope as soon as possible.