The importance of communication and support for carers, and how to achieve an outstanding rating from the Care Quality Commission (CQC)

Simon:
I'm Simon Osborn, I'm the director of Quality in home care and also clinical care from Right At Home. Right At Home was started by our owner and now chairman Ken Deery In 2010, In Liverpool. Right At Home has always had a real family feel, Ken, being the, the innovator and the entrepreneur that he is, he started the business and he's still very involved and still very much driving out our culture. We expect very high standards and that's what helps to get us our very high ratings with, with CQC But we balance that high challenge with a very, very clear culture of high support.

Shaked:
You have vast knowledge with CQC, right? Because you were there for seven years?

Simon:
Seven years? Yes. I started off in 2012 as a what was then called a bank inspector, which is the part time inspector helping out because that was using a previous methodology. I moved on then in 2014 to take up an inspection manager role, which I held from 2014 to 2019.

Shaked:
Why should someone become a franchise owner rather than starting their own agency?

Simon:
There's two main points to make here. One is about not launching one's own business just from scratch, clearly, it is very difficult to establish one's name in a large sector like the care sector. And what happens with franchising in the care sector is obviously that a franchise owner is buying into a trusted brand and there are many trusted brands in franchising in the care sector, It's not exclusive to Right At Home, but what I would really, really say it's Right At Home is really a trusted brand in the care sector. The other key point to make about franchising in the care sector is about the support structure. So when you start off on day one as a business owner, if you have no experience in care, it would be very challenging to navigate the complexities of the care sector. It's still is, but what a franchise owner has behind them when they join Right At Home or the other franchise brands is a very, very clear support structure. From day one, the franchise owner gets a trusted brand that they can market and be part of, so they are trusted from day one and they get the intensive support that goes with being a franchise owner with Right At Home.

Shaked:
Six out of ten complaints of carers is that they feel alone, that they feel a lack of communication with the head office. How can we bridge that gap and put the carers in the center in order to deliver better care?

Simon:
It is about communication channels. What our franchises have always, always focused upon is regular team meetings. There is a balance between giving policy update and informal communication as well as giving the safe space in which caregivers can be honest about the job is pressurized, the cost of fuel and food, etc. You know, our caregivers still operate in a low paid sector and that's a big issue for them. So if they have issues outside of work, they need a safe space in which to express those because if those areas are not supported, It's going to be very difficult for the franchise to be successful in giving a holistic approach of support to those caregivers.

Shaked:
The main pain of carers is the day to day when they feel that they're stuck there, no one mentors them, no one cares about them, just after 60 days, 90 days, you do the reassessment, that's where you meet them.

Simon:
We do use digital technology, we have a number of platforms that we use for care planning, etc. Those platforms have a mobile app, the caregivers all have a mobile phone that communicates with the office and they will get an immediate response from the coordinators or from the registered manager. Outside of working hours, that mobile app is immediately and automatically connected to the out-of-hours support so that if people are working late into the evening, if they have a care call at 21:30 in the evening, there's nobody in the office, but they are immediately connected to the on call service and there is an on call service in every one of our franchises.

Shaked:
I know that CQC doesn't really appreciate WhatsApp as a communication tool with carers, Do you know why?

Simon:
There were some concerns from the regulator perspective, I think around safety. The other issue we find generally with the use of, let's say, social media for communication in a professional sense is sometimes some caregivers might stray into using that professional communication in a more casual manner. Our view is very, very much that we are looking, as I say, to innovate in a way that gives a direct and discreet and individualized method of communication, which is secure and which is totally separate from any social media that the person uses. And so they know that is dedicated to professional communication.

Shaked:
What's the mindset that I need to have in terms of managing my carers in order to get the outstanding rating from CQC?

Simon:
The culture is what we describe as a culture of going above and beyond. We believe that sets us apart, not just us, but high quality organizations, Because they go above and beyond every day. The service and the care that is given to clients is of the very highest quality. It's also about doing that with caregivers in terms of going above and beyond.

Shaked:
Let's say that I want to take this mindset and strategy and implement it in my agency. How do I measure that my carers actually trust me and the clients trust their carers? How do they measure that the recognition actions that I take, they actually have impact? How can I measure it on a daily basis?

Simon:
My team, they visit every franchise in their portfolio, so they will speak to the office staff, they will speak to caregivers. We have a semi independent view, but an internal review which is really important. We also complete an annual full audit ourselves. I never ever, ever want the CQC to find an issue that we don't know about first and that we have not done something about it to fix it first.

Shaked:
As a CQC inspector you go and speak with carers, caregivers, right? What do you ask them to make you determine whether they are going to get an outstanding rating or below that?

Simon:
An inspector will usually ask a caregiver about their knowledge around key areas of practice, safeguarding. so how do you make sure people stay safe, and what do you do as a caregiver if you don't believe a person is safe. Another area is what we call the MCA, which is the Mental Capacity Act. Assessing capacity, they don't have to do that personally on a formal basis, but they should be doing that on an informal basis on a day to day basis and reporting any concerns about a person's capacity. So that's the technical. What they will more focus on, though, that we've discussed is the support. What support is the caregiver being given both formally in terms of team meetings. All of our caregivers in every franchise are offered regular one to ones where they will sit down with their line manager and then they have that time on a one to one basis to talk about any concerns, any challenges, to plan for how those will be addressed, etc.. So the inspector will be very much asking what level of support is the is the caregiver being given, How is the caregivers knowledge and skill base being developed.

Shaked:
What would be the key things any care provider need to invest in, in order to increase their caregivers retention?

Simon:
Any individual provider needs to be very focused upon pay, but also on, on training and I would say on innovation. But from an individual provider perspective, from a franchise perspective, then I would say investment in technology is really, really important to look at pay. But also to look at retention and also career progression.