Below is a detailed description of how the CQC would characterise an ‘outstanding’ service from the point of view of effectiveness. It begins with an overall definition of ‘Effective’ and then gives an overall ‘outstanding’ characteristic of an ‘Effective’ service. Then it breaks down this overall characteristic into a number individual parts using the Key Lines of Enquiry (KLOEs) for this domain (E1, E2, etc).
|By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence|
|Outcomes for people who use services are consistently better than expected when compared with other similar services. People’s feedback about the effectiveness of the service describes it as exceptional and distinctive|
|E1: Are people’s needs and choices assessed and care, treatment and support delivered in line with current legislation, standards and evidence-based guidance to achieve effective outcomes?|
|The service works in partnership with other organisations and keeps up to date with new research and development to make sure staff are trained to follow best practice. Where possible, the service also contributes to the development of best practice and good leadership with other agencies.
There is a truly holistic approach to assessing, planning and delivering care and support. The service looks for and encourages the safe use of innovative and pioneering approaches to care and support, and how it is delivered. New evidence- based techniques and technologies are used to support the delivery of high- quality care and support.
|E2: How does the service make sure that staff have the skills, knowledge and experience to deliver effective care and support?|
|People using the service, their families and other carers are supported to take part in the recruitment of staff and volunteers and have an influence on the outcome.
Staff training is developed and delivered around individual needs. People, their families and other carers are involved in planning and delivering this training.
Training is tailored to the individual needs and learning styles of staff.
There is a proactive support and appraisal system for staff, which recognises that continuing development of skills, competence and knowledge is integral to ensuring high-quality care and support.
|E3: How are people supported to eat and drink enough to maintain a balanced diet?|
|There is a strong emphasis on the importance of eating and drinking well. The service provides good quality food with a variety of different options to choose from each day. People are fully involved and help to plan their meals with staff, taking nutritional advice into account. Staff are aware of people’s individual preferences and patterns of eating and drinking and there is flexibility when needed or requested.
Creative ways have been introduced to encourage food to be as attractive as possible when people are on specific diets, for example soft diets.
Innovative methods and positive staff relationships are used to encourage those who are reluctant or have difficulty in eating and drinking.
The service embraces different cultural, religious and ethical issues around people’s choice of food to make sure their wishes are respected. There is a creative approach to food from different cultures, for example making it available on particular days for festive celebrations.
There is positive feedback from dietetic professionals that the service asks for their advice and applies it properly.
|E4: How well do staff, teams and services within and across organisations work together to deliver effective care, support and treatment?|
|There is a thorough approach to planning and coordinating people’s move to other services, which is done at the earliest possible stage. Arrangements fully reflect individual circumstances and preferences.
Staff, teams and services are committed to working collaboratively and have found innovative and efficient ways to deliver more joined-up care and support to people.
|E5: How are people supported to live healthier lives, have access to healthcare services and receive ongoing healthcare support?|
|There are champions within the service who actively support staff to make sure people experience good healthcare outcomes leading to an outstanding quality of life.
The service sustains outstanding practice and improvements over time and works towards, and achieves, recognised accreditation schemes.
The service empowers people to make choices about their health and how it should be monitored and managed.
Where people have complex or continued health needs, staff always seek to improve their care, treatment and support by identifying and implementing best practice. Links with health and social care services are excellent.
|E6: How are people’s individual needs met by the adaptation, design and decoration of premises?|
|The service uses innovative methods to engage people in discussions and decisions about the environment they live in or use. This means people’s environment reflects their individual preferences and culture, and supports their needs in the way they choose.
The service is designed around people’s needs and wishes and uses innovative ways to help people to be as independent as possible. Where possible or appropriate, people are encouraged to help with decorating or furnishing the premises.
There are different areas for people to use for their preferred activities, and private space to spend time with their families or visitors, or to have time alone. All areas are maintained and decorated to a high standard, in a way that people have asked for, and take into account people’s cultural needs for how the space is used. Space is maximised and used creatively to promote independence.
New equipment and technologies are used to support the delivery of high- quality care and independence. This is personalised so the equipment used is the most suitable for individuals. People are able to do more things independently, or carry out existing tasks more comfortably, easily or quickly.
|E7: Is consent to care and treatment always sought in line with legislation and guidance?|
|The service is skilled in how it obtains people’s consent for care and treatment, involving them in related decisions and assessing capacity when needed, even where disability or other impairments make this very difficult.
The service has a very flexible approach to any restrictions it imposes on people; keeping them under constant review, making them in a time-limited way, and only when absolutely necessary.
Practices regarding consent and records are actively monitored and reviewed to improve how people are involved in making decisions about their care and treatment. Engagement with stakeholders, including people who use services and their family, friends and other carers, informs the development of tools and support to aid informed consent.
The service has nominated champions for mental capacity, restraint and consent. They make sure that staff are fully educated and trained and have a comprehensive understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
Staff are confident about using the Mental Capacity Act 2005, and use innovative ways to make sure that people are involved in decisions about their care so that their human and legal rights are respected. Best interest decisions are always made in accordance with legislation and people’s wishes.