Bradford Care Association

BY Helping hands of harrogate

Uploaded on January 20th, 2017.

How to be rated 'outstanding'

If you work hard at providing a high quality health or care service, positive feedback is affirming that you’re on the right lines, as well as being recognition of all your efforts.

Positive feedback is motivating and encourages you to be the best carer, manager or company owner that you can be. Direct feedback from your customers is essential information that enables you to make a judgement about your own performance.

If feedback from your customers is positive, you would also want positive recognition from the CQC.  If you believe you are providing a high quality care service, it becomes your job to describe and evidence how you know you are achieving this.

The CQC provide lots of helpful material to guide  providers  on what a high quality service looks like and how we can deliver  a service that is high performing in line with the five key lines of enquiry (KLOEs) Safe, Effective, Caring, Responsive and Well Led*.

This article is not going to repeat this content, but rather describe how Helping Hands of Harrogate used these documents to support our achievement of Outstanding in Safe and Caring and an overall rating of Outstanding.

We hope that sharing our approach and experience will give you some tops tips on how to manage the inspection process, feel more prepared, in control and confident in your ability to evidence to your Inspector that your service is of a high quality. Having an increased sense of confidence will enable you to positively showcase your achievements in the sometimes uncomfortable face of scrutiny. We hope it will support you to achieve the outcome you want and the one your team deserves.

Planning, preparation and portfolio are just three keys out of a whole  bunch that are needed to unlock the door to an improvement in your current rating or achieving the best rating you can in your first inspection under the current process.


Know what rating you want to achieve. Our management team’s first job was to share this goal with all carers and support them to make links between what they do on a day to day basis, the KLOEs and the achievement of a particular rating. Don’t keep this information to yourself; share this widely in a proportionate way that makes sense to your team.  We shared this information through informal chats, formal supervision sessions and team meetings.

Carers welcomed such discussions and enjoyed describing what they do well and the positive impact it has on the lives of the people they support. Such discussions gave team members the opportunity to share their ‘magic moments’, share those specific times when they felt they had made a positive difference and made their role feel rewarding and worthwhile.

These conversations really helped employees to describe with passion what care teams do well,  the positive impact of their involvement in people’s  lives and also goes some way in the identification of exceptional and distinctive practice. A record of these events will provide a great source of tangible evidence to support the achievement of the rating you are aiming for. It also goes someway to prepare staff to talk to Inspectors about the things that go really well rather than focussing on the things that don’t always go as planned.

This process may also help you identify evidence of creative and innovative practice and can make carers feel much more confident when talking to inspectors rather than shaking with fear about saying something wrong!


The completion and return of your Provider Information Return is essential if you are asked for it by the CQC.  See this as an opportunity to make use of a helpful tool that gives a structure to your portfolio of evidence rather than a time consuming headache. If you have done your planning and preparation well the pain of completion will be less.

We took the completion of the PIR as an opportunity to tell the inspector about our achievements prior to the inspection, which gave us organisational confidence. We viewed the actual inspection days as the opportunity showcase a portfolio of supporting evidence to demonstrate what we had said. It gave us a structure, simply ‘describe and show’. We presented evidence in whatever form demonstrated that our service is of an outstanding quality. We provided evidence in a range of formats for example a short video clip that ‘said’ the same as a thousand words.

Completion of the PIR supports you to understand in some depth your service at all levels. It helps you check whether the service you are delivering is actually being delivered to the standard you think it is. It helps identify the areas you can improve upon to ensure your service is high quality in all areas. Be prepared to describe what you are going to do to build on what you are already doing to improve your service and be able to describe what impact you anticipate this will have on people you support by relating this to the KLOES.

Having this supporting evidence to hand will prompt thoughtful and reflective discussions with your Inspector. Knowing your service in depth will serve to demonstrate just how well led your service is. It will increase your confidence, support the development of your strategic service plan, support the performance management of your team members at every level, enable you to articulate to your team the service’s direction of travel and motivate your whole team to achieve the mission of your organisation, namely delivering a high quality service and the part they play in contributing to this.

Our approach was embraced by our Inspector. Inspectors will be under scrutiny to explain to their Regional Managers how they reached a judgement about your service with supporting evidence; our approach helped her do this.…. Deep breath….. WE ARE ALL ACCOUNTABLE!


* Relevant Provider Handbook for your service

  Appendix A KLOE’s

  Appendix B Characteristics of each rating level


A carer supporting a ten year old boy with learning disabilities was overjoyed at the positive impact achieved through her involvement.

Over time she watched him become more confident through having a greater sense of self and a greater belief in what was possible for him to achieve. She felt she had made a real difference to his life encouraging him to take risks to develop his skills, abilities and be open to new experiences.

Whilst being sad that she would finish supporting him because he no longer needed it, she was euphoric that she played a part in him being able to attend his chosen leisure activity without formal support, enjoy himself with new people and have the opportunity to make friends.


A carer described supporting Rachel in the final stages of life as one of the hardest things that she had ever done yet was thoughtful that the experience would never leave her, helped her grow as a person and carer.

Rachel’s mother said that the carer’s involvement with their family had such a positive impact on her daughter’s experience of deteriorating health and death. She went on to describe the impact being like a ‘pebble in a pond’ having a lasting, positive ripple effect on them as parents, wider family and friends and other professionals.

Our carer felt it was an honour to have been involved at this time and has since gone on to share her experience with her team colleagues.



Carers described a great sense of satisfaction in supporting Dana to develop the skills to manage her own skin integrity rather than them making decisions on her behalf. Dana was given current best practice guidelines on how to manage erythema (reddening of the skin).

Her carer would take photos of reddening, show them to Dana and she would then make decisions about what needed to happen next. The impact of this approach resulted in Dana’s skin not breaking down, a reduced involvement of community health professionals and Dana enjoying the freedom to be part of new leisure pursuits previously not possible because of the presence of pressure sores and a limiting skin care plan. Her carers delighted in Dana being able to take more control over her own life through enabling her to safely manage her own health needs.

This approach resulted in Dana enjoying improved health and sense of emotional wellbeing.



Make written and visual records, write case studies and collect documents from all levels of your service that evidences different characteristics across the KLOEs.

Whilst the necessity of such preparation can make the most motivated of people put their head in their hands, prioritising this alongside the actual act of delivering high quality care may prevent a sense of dread about inspections.

Be confident, help your team to describe when they are getting it right, praise individuals when things go well and share it with others. Start to collect sources of evidence across the KLOEs that show characteristics of each rating level, this approach will help to start inform your thinking about what is a realistic outcome of an inspection process and it will give you a very good idea about what is achievable, where you need to focus your energy on areas for improvement and reduce the likelihood of disappointment.

Where things haven’t gone as planned don’t fear being found out, be prepared to demonstrate your duty of candour by describing honestly what happened and how you responded, what action you took to prevent a similar incident and show your understanding of the positive impact your action achieved.

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