Quality Assurance Framework - proceduresonline.com

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Adult Social Care

Right Help, Right Time to Promote Independence

Quality Assurance Framework

Author: Clare Hall-Salter, Service Delivery Manager, Service

Improvement & Efficiency

Date: April 2018

Version: v3

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Quality Assurance Framework Governance

Title Quality Assurance Framework

Purpose/scope To support and enable Adult Social Care to ensure

the best quality support for residents who have care or support needs, within the resources available

across our community

Subject key words The development of good quality services on the following principles and activities:

• Self help, self management and supported assessments

• Single team approach minimising the number of hand-offs tolerated

• Integration when and where it makes sense

• Professional judgement

• Proportional assessments

• I.T. Solutions and system redesign

• Safeguarding

Council Priority Protect and support our vulnerable children and

adults Improve the health and wellbeing of our

communities and address health inequalities

Lead author & contact details SDM – Service Improvement & Efficiency

Date Established February 2016

Date Revised November 2017

Date Reviewed April 2018

Date of Next Review April 2019

Service Improvement &

Efficiency Validation

April 2018

Legal Sign Off n/a

Finance Sign Off n/a

Approver Adult Social Care Leadership Team

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Content

1. Our Approach to Quality Assurance

2. Why do we need Quality Assurance?

3. What are our Quality Assurance Principles?

4. Why do we need a Framework?

5. What can we deliver?

6. Standards

7. Corporate Governance

8. Roles and Responsibilities

9. Activities and Methodology

10. Common Sense Approach

11. Actions and Learning Outcomes

12. Meetings and Reporting

13. Who else do we work with?

14. Appendix

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1 Our approach to Quality Assurance

In Adult Social Care, quality starts from what matters most to enable people to live

their lives in the way they want. By definition, there can be no ‘one size fits all’ in

personalised care and support. Getting the right balance for people can only be

achieved through a person-centred approach which understands someone’s

personal history, current circumstances, future aspirations and what is important to

them. This may change over time – so it is important not to make assumptions.

For most services, the consumer will decided what a quality service means to them

and this is how it should be. A care and support service can only be considered high

quality if:

It places the person receiving the care at its centre

It enables personal outcomes to be achieved

The relationship between the person who is using the service and the people

who deliver it is based on dignity and respect

2 Why do we need Quality Assurance?

High quality care and support exists where people who use social care:

Are enabled to live independent as defined by them, with informed choice and

control through access to appropriate care and as much involvement in

decisions about care and support as they want to have

Have opportunities to participate in community life, engage in activities that

match their interests, skills and abilities and maintain good relationships

Feel safe, secure and empowered because their human rights are

safeguarded while they are supported to manage informed risks

Have a positive experience of care provided through relationships based on

mutual respect and consideration, where care is designed around their needs

and is consistent and co-ordinated.

Through quality assurance we seek to evaluate what we do as a service,

identify and consolidate strengths, address weaknesses and learn as a service

in order to improve what we offer and deliver to residents with care and

support needs.

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Through a range of measures we ask:

What we are getting right as a service?

What could we do better?

Are we doing things the best way with the resources we have?

How well are we working with individuals, families and carers?

Are we delivering our commitment to promote independence, ensure safety and support recovery?

Are we safeguarding vulnerable adults?

Are we fulfilling our duties and working within regulations?

Are we meeting and upholding standards of best practice?

Are we supporting our staff to carry out their jobs safely and effectively?

These questions are based on a range of documents and policies that set standards, define quality and capture what we mean by ‘getting it right’, including:

Right Help, Right Time to Promote Independence

Care Act 2014 and

Mental Capacity Act 2005

Being the Change One Year On HCPC Regulations

Co-operative Council Values Audit and Financial Codes and Regulations

Complaints Policy Supervision Policy/Guidance

Think Local Act Personal: Making It Real

Adult Social Care Policies and Procedures

Information Governance and Caldicott Guardian

File Audits/Observations Guidance

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3 What are our Quality Assurance Principles?

We aim to establish a ‘quality culture’ whereby quality assurance is not just a formal process but a shared attitude focused on

continuous improvement.

Leadership To be visible and proactive, connected to service outcomes and able to inspire people to have high

aspirations for themselves and others.

Voice The voice of people using the service, their family carers and supporters must be positively welcomed

through genuine involvement in sharing and providing feedback

Culture The culture within which care and support is provided will be positive, open and respectful with an ethos

that is proactive, and person and relationship-centred. Dignity, empathy and compassion should be

evident.

Workforce The workforce will comprise considerate, competent and highly motivated people, including managers,

whose values, attitudes and behaviours reflect the primary focus of supporting and empowering people to

have the best possible quality of life.

Workforce and service development should inspire those involved and encourage imaginative practices

that enable people to achieve good outcomes.

Education and Training Is integral in an environment where supervision and appraisal is used to help encourage continuous

professional development as well as to ensure that objectives are met.

Accountability For quality, this will be clear and transparent to all, whatever forms the service takes and whichever

organisation or individual provides the service

Professional Standards Will be maintained with accessible, objective expert advice. People who use services are experts by

experience and can provide such advice. All staff qualified and unqualified will follow relevant codes on

conduct.

Participative We want everyone to participate and engage in quality assurance. Staff and service users have an

important role and we value citizen insight. We want to encourage awareness of quality issues and

ownership of findings.

Supportive We want staff to feel secure in learning from feedback and be able to deliver quality practice. We want

feedback to be seen not as a threat but as an opportunity to learn and make a difference. We will

celebrate as well as challenge

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Feedback Cycle We want quality assurance to work as a continuous cycle not as a series of isolated events. Carrying out

an activity is just the start. We want to use findings proactively to learn as a service and deliver better

outcomes. We will use clear feedback mechanisms so that learning is applied, monitored and reviewed.

Outcome Based We focus on outcomes as well as outputs and we want to improve performance and measure impact. We

want to find out whether individuals are better off as a result of our interventions and whether their

identified needs have been met.

Joined Up We want our activities to link to quality assurance across the council and partner organisations. We are

interested in what they can tell us, what we can learn and what we can share

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4 Why do we need a Framework?

We have a framework in place to focus the different elements of quality assurance

activity carried out by the service and by partners.

The framework provides structure, coherence and consistency by defining:

Who does what? How? How often? What tools are used?

What actions are taken?

How are results fed back to the service and to service users?

How does learning take place?

5 What can we Deliver?

We aim through quality assurance and learning mechanisms to support and enable

Adult Social Care to:

Identify and act upon strengths and weaknesses

Gain insight into whether the service is supporting the right people, the right way at the right time and making a difference

Carry out work to the highest standard and set clear expectations to ensure best practice

Work in the best interests of people

Fulfil organisational priorities and service commitments

Continually learn and improve

Deliver quality and value for money incorporating the co-operative values underpinning the council priorities

Prioritise areas for improvement and development

Identify which interventions work Replicate best practice

Identify gaps within practice and services offered, which can be addressed through service planning training and commissioning

Ensure staff are supported in carrying out their jobs safely and effectively

Follow the journey of the individual through our services

Give priority in service delivery to helping people recover, recuperate, and rehabilitate so that they are able to live as independently as possible

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6 Standards

Standards are being developed to support the improvement of practice relating to the

quality of practice and intervention. The standards and associated tools provide

managers and practitioners with clear guidance to drive the process and to maximise

support to people. By using these tools it provides a consistent approach to quality

assurance and audit.

7 Corporate Governance

Corporate Governance is the set of processes, customs, policies, etc which ensures

that the council operates effectively. It provides a framework for staff and elected

members to operate in which engenders trust in the organisation. An important

theme of corporate governance deals with issues of accountability through

implementation of policies and mechanisms to ensure good behaviour and protect

the public, staff and the council. The key policies that we have in place are:

The Constitution

Local Code of corporate governance

Employees Code of Conduct

Members Code of Conduct

8 Roles and Responsibilities

There are many stakeholders in the quality of our service; roles and responsibilities

reflect this.

Although a series of structured activities will take place across the course of a year,

which are detailed in Appendix 1, quality assurance should be an integral part of

everyday practice. For this reason everyone has a role. All staff providing services

are accountable for making sure standards are met at all times. Service users and

internal and external partners also have contributing roles in our quality assurance

and learning.

People who uses services, citizens and carers can help to drive up quality by being

supported to:

Make informed care choices about how their care is provided. This requires

time to talk to people already using services and access to clear,

straightforward information (including user feedback), advice and where

appropriate, advocacy

Feel assured that services will keep people safe and treat them with dignity

and respect, as well as having high expectations that services can provide

what individuals want.

Let services know the things that matter including cultural needs and personal

preferences, however small, with confidence that they will be taken into

account

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Speak out with confidence or formally complain if quality is not good enough.

People using services who are less able to do this should be supported to

come forward to give feedback on their experiences and if necessary

complain

Contribute to quality assurance activities for the service, i.e. service user

consultations or survey, regulatory visits, Making It Real Board, etc

Play a role in developing services (co-production).

9 Quality Assurance Activities and Methodology

Appendix 1 gives detail of the structured quality assurance activities, including

frequency, roles and arrangements for learning, feedback and follow up.

Although the activities differ in depth, detail and involvements they share a common

methodology:

Evaluation stage Step 1 Gather evidence

Step 2 Reflect and evaluate evidence against quality standards derived from policy etc

Step 3 Judge quality and identify anything that falls short, strengths and weaknesses

Learning and Improvement stage

Step 4 Define actions to address strengths, weaknesses and concerns

Step 5 Feedback to relevant audience (actions/learning)

Step 6 Follow up to ensure actions have been implemented and have made an impact; share outcomes with relevant audience

This methodology also applies to the ‘everyday practice’ quality assurance that is

also summarised in the Appendix 1as practitioners self-evaluate quality and take

action as they go about their daily duties. Quality evaluation is also an essential part

of management oversight and supervision.

The service might not be involved in every stage. For example, a different team or

organisation might gather evidence and make recommendations to which the service

respond in the learning and improvement stage. Service users may be the lead or

be consulted in the evaluation stage and also be involved in the learning and

improvement stage.

The service might seek input from partners outside the service in the evaluation

stage or feed back to them during the learning and improvement stage. For

example, when learning from a complaint relating to a social care client who has

received commissioned care.

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Some steps will be broken down into sub-steps. For example, a team leader might

define case specific/practitioner specific actions as the result of a case file audit but

further thematic or learning actions will arise after audit findings are collated and

emerging themes discussed by the leadership team.

10 Common Sense Approach

Above all, we are guided by common sense.

Activities should be proportionate and informed by the type of service provided, the

risks and regulatory framework. Participation should be appropriate. Actions

identified should be proportionate and be given appropriate timescales. If something

can be done straight away, particularly where a client is affected, it should be done

straight away.

We expect all members of staff to act if they identify a potential quality issue, such as

an incorrect recording. This might be something they can remedy themselves. If

not, they will notify the relevant manager/practitioner or their own supervisor.

It is imperative that we share learning with the right people and use it meaningfully.

This is guided by:

Who needs to know?

Who else could benefit from knowing or learning?

For example, some local or case specific actions will not need to be shared further

but others are relevant to the whole service. Some concerns might need to be

escalated. Some learning will need to be shared outside the service or beyond the

organisation.

We will give immediate feedback where possible, especially to service users. We

value their insight and want them to see a direct link between their participation and

the outcome; how what they said resulted in what we did.

We will appraise our quality assurance activities to check they are fit for purpose and

are making a difference.

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11 Actions and Learning Outcomes

All quality assurance activities, whether they identify good practice or poor practice,

should result in the definition of actions that will help the service to learn and

improve.

Many actions will be local or case specific and will usually be identified by team

leaders or senior practitioners. Others will be service level and will be defined and

prioritised at leadership or formal learning meetings. The Principal Social Worker

has an important role in identifying emerging quality issues and making

recommendations.

Although actions will vary in detail common categories will be:

Learning/Improvement Action

Case level remedial action

Practitioner level training/support need

Correcting a recording error

Further in depth exploration – including via learning outcomes meeting

Team level training/development need

Service level training/development need

Requirement to reinforce knowledge of process/policy/guidance

Requirement for clearer guidance

Requirement for process/policy review

Requirement for system review

Requirement for review of resource

Requirement for further quality assurance activity e.g. thematic audit, deep dive, dip sample, internal audit request, review of performance data

Share good practice/innovative practice at team level

Share good practice/innovative practice at service level

Incorporate positive case study into training/development

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12 Meetings and Reporting

The main forums for discussing the findings of quality assurance activities,

formulating service level actions and sharing learning will be:

Adult Social Care Finance and Performance Management Meeting

This monthly meeting provides strategic and leadership oversight and scrutiny of

professional and organisational performance and systems and financial

effectiveness and efficiency in Adult Social Services. The meeting also identifies

and responds to key risk factors affecting the performance of the service. The

meeting meets monthly and is led by the AD Adult Social Care and supported by

the SDM: Service Improvement and Efficiency. The meeting is chaired by the

Assistant Director for Adult Social Care and membership includes:

• Assistant Director

• Service Delivery Managers,

• Team Leaders/Seniors

• Finance

• Organisational Delivery & Development

This meeting carries out quality assurance activity in the form of evaluating

performance data. It also examines evidence reported from quality and audit

activities and agrees or defines actions.

Adult Social Care Leadership Team Meeting

The meeting is chaired by the Assistant Director for Adult Social Care.

Evidence from quality assurance activities is reported monthly, quarterly and

annually by Service Improvement & Efficiency, Principal Social Worker and others.

Members of the meeting review the reports and recommendations and agree or

define service level actions. These are recorded and tracked via the Improvement

Plan.

Learning Outcome Meetings

These meetings take place on a quarterly basis and are led by a Principal Social

Worker. They provide strategic and leadership oversight and scrutiny of

professional and organisational activity in response to improvement and quality of

social work and social care practice. The outcomes from these meetings will be

shared with the Leadership Team. The membership of this meeting includes:

• Assistant Director

• Service Delivery Managers,

• Team Leaders/Seniors

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The meeting provides formal assurance to quality assurance process overseeing

and signing off professional and organisational activity in response to performance

management, improvement and quality assurance of service activity.

One off specific

Specific Learning Outcomes meetings may be called, as appropriate, to enable

learning in response to specific concerns.

Staff Briefings, Learning Workshops and Forums, Team Meetings

Staff briefings and team meetings are held on a weekly, monthly and quarterly

basis depending on the level of communication necessary for each team.

Learning workshops and Forums and Staff training sessions are organised to

ensure that all staff receive up to date training, updates on relevant offers and

changing priorities within the teams.

13 Who Else Do We Work With?

This Quality Assurance Framework is focused on the activity of Adult Social Care

services and therefore has links to other quality assurance processes and systems

across all services in health and social care including commissioned services. These

include:

• Health & Wellbeing Partnership Boards

• Making It Real Board (in development)

• Carer’s Partnership Board

• Adult and Children’s Safeguarding Boards

• CQC Information sharing meeting

• Democratic Scrutiny arrangements

• Internal Audit

• Customer Experience team

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Appendix 1 Quality Assurance Activity

Activity& Frequency Tools/guidance Category Roles, feedback and follow up

Case file audit & observation of practice Monthly - one case per team and per SDM selected randomly Monthly reporting & learning outcomes

Checklist Process Map Guidance

Practice/ Outcomes/ Client journey

TL/Senior/SDM uses checklist to evaluate evidence, judge quality of work, identify good practice and define priority weighted local actions; documents copied to SIE

TL/Senior/SDM shares findings with practitioner(s), celebrates good practice and discusses improvement actions

TL/Senior/SDM monitors completion of actions by practitioner(s) via supervision; SIE are updated

SIE/PSW complete quarterly moderation exercise to ensure a consistent benchmark is maintained

SIE report monthly to ASCLT on audits completed, findings of moderation and progress against individual case actions

PSW (supported by SIE) reports monthly at ASCLT on emerging learning themes based on collated data

ASCLT review reports and agree service level actions

TLs circulate/feedback to teams

SIE update ASCLT Action Plan and set a review date for evaluating impact as evidenced through subsequent audit findings, nominated leads complete actions and SIE monitor progress

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Thematic audits/Thematic Practice Reviews/Deep Dive Audit/SARs Quarterly as part of annual programme and as required

Practice/ Outcomes/ Client journey

ASCLT identify programme; PSW/SIE co-ordinate

Audit/Review Group evaluate evidence (including discussion with practitioners and family conversation if relevant), judge quality of work, identify good practice, areas for improvement, learning themes and corrective actions; documents copied to SIE and TLs/Senior of case holding practitioner

TL/Senior shares findings with practitioner(s), celebrates good practice and discusses improvement actions

TL/Senior/SDM monitors completion of case specific actions by practitioner(s) via supervision; SIE are updated

PSW (supported by SIE) collates findings and reports to EHSLT on learning themes

ASCLT review report and agree actions


Outcomes shared with service user/family if relevant

SIE update ASCLT QA Action Plan and set a review date for evaluating impact as evidenced in subsequent audit findings; nominated leads complete actions and SIE monitor progress

SARs procedures can be located here@ http://www.telfordsafeguardingadultsboard.org/sab/info/1/home/4/information_for_professionals_carers_and_health_workers

Analysis of performance/ finance data, including ASCOF performance Monthly

Dashboard Data set Prepared by ODD

Output/ Outcomes

Data is presented and discussed at ASC Finance and Performance Meeting

Members of meeting agree actions based on emerging performance and quality issues and other trends

Performance data and outcomes cascaded to service as relevant

SIE note service level actions on Action Plan, leads progress and SIE monitors completions

http://www.telfordsafeguardingadultsboard.org/sab/info/1/home/4/information_for_professionals_carers_and_health_workers

http://www.telfordsafeguardingadultsboard.org/sab/info/1/home/4/information_for_professionals_carers_and_health_workers

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Data quality reporting/ clean up Ongoing

Whole scale data cleansing carried out as part of implementation of new case management and financial system for ASC

Go live October 2018; thereafter monthly data quality reporting to ASCLT and associated actions

Social Work Health Check Survey/Whole Workforce Annual

Survey Guidance

Workforce/ Practice

PSW (supported by SIE) facilitate survey

Practitioners complete survey

PSW (supported by SIE) evaluates evidence and presents short report to ASCLT with analysis and recommendations

ASCLT review report and agree actions

Report on survey outcomes shared with service

SIE update action plan and set review date for evaluating impact and monitor progress against actions; nominated leads complete actions and SIE monitor progress

Other staff feedback/practitioners forum monthly

Workforce/ Practice

Staff feedback is invited via staff briefings and other opportunities

Supervision Audit Annual (minimum)

Supervision policy Process map

Workforce/ Practice

PSW/ASCLT completes audit of supervision and reports findings to ASCLT and actions followed up with leads

Case quality dip sample – linked to Supervision Monthly

TL/Senior completes dip sample around case quality prior to supervision to inform supervision discussions around quality issues and reinforce good practice

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Learning from complaints/ compliments/ comments/ MP enquiries Ongoing, informed by statutory timescales Monthly reporting

Process map Guidance Learning checklist

Service user experience

TL/SDM/AD and SIE investigate and resolve individual complaints in coordination with Customer Experience Team (CET) and identify actions; coordinate with other teams, partner agencies or commissioned services might be required

TL/SDM/AD share actions with complainant via the formal response and cascades actions to relevant leads (including from other teams or agencies)

SIE monitors progress against actions in coordination with CET

CET feedback to complainant on completion of actions and outcomes

SIE analyse data report quarterly to ASCLT on number of complaints, adherence to statutory timescales, completion of actions and emerging learning themes

ASCLT examine report and agree service level actions


SIE update ASC QA Action Plan and set a review date for evaluating impact as evidenced in subsequent findings; nominated leads complete actions and SIE monitor progress

CET publish annual report

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Local Government & Social Care Ombudsman (LGO) enquiries, and Caldicott Guardian referrals Legal gateway access panel Monthly


LGO investigate in cases where complainant has been dissatisfied with LA response to a complaint; LGO evaluates evidence, decides if fault is found and makes recommendations to remedy any injustice (complainant is informed)

AD/SDM agrees and implements recommendations; SIE update Information Governance (IG) and IG notify LGO

SIE report annually to ASCLT on number of enquiries, decisions and recommendations

ASCLT examine report and identify any further learning actions


IG produce annual report

LGO publish annual national report

Adult Social Care Survey and Carer’s Survey Annual/bi-annual as per timetable set by NHS Digital

NHS digital guidance .gov guidance


Personal Social Service Adult Social Care Survey is administered by Organisational Delivery & Development (ODD) on behalf of NHS Digital

Personal outcome information provided by a sample of people receiving a service funded by LA or managed by adult social care supply, including judgments around how well we meet user and carer needs

This data contributes to NHS Digital’s published report but is also evaluated and used locally to inform delivery of service and support/monitor/develop standards

Reported to ASCLT Performance Meeting by ODD?

Cascaded?

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Other Service User Feedback e.g. Service user forums Locality events feedback Mystery Shopper


Feedback on quality of intervention and how we could improve in future

Making It Real Board Monthly


The Making it Real Board have an established and agreed Action Plan and have made a decision to work through the 3 top priorities from the ‘I’ Statements.

Further details on the work of the Making it Real Board is located here: https://eteam/sites/partner/ServiceImprovementEfficiency/Shared%20Documents/Forms/AllItems.aspx?RootFolder=%2fsites%2fpartner%2fServiceImprovementEfficiency%2fShared%20Documents%2fPPQ%20Team%2fInformation%20and%20Advice%20Officer%2fMIR%20Board&FolderCTID=&View=%7bE7E387ED%2dFD14%2d475F%2d95F2%2d60BF34A152E0%7d

https://eteam/sites/partner/ServiceImprovementEfficiency/Shared%20Documents/Forms/AllItems.aspx?RootFolder=%2fsites%2fpartner%2fServiceImprovementEfficiency%2fShared%20Documents%2fPPQ%20Team%2fInformation%20and%20Advice%20Officer%2fMIR%20Board&FolderCTID=&View=%7bE7E387ED%2dFD14%2d475F%2d95F2%2d60BF34A152E0%7d





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MyLife portal site feedback

Citizen experience/ Promoting independence

Citizens are invited to give feedback through the site

Internal audits As per audit work plan Quarterly reporting

Final and follow up audit report templates Regs (Supported by SIE)

Internal governance

AD/SDMs coordinate with Lead Auditor to devise annual audit work plan with requests informed by quality assurance priorities

Auditor (Information Governance, Insurance & Audit) evaluates evidence, decide audit opinion, make recommendations and identify areas of good practice

SDM/lead officers agree actions in response to recommendations

Auditor finalises report; SDM/leader officers share with service

SIE monitor progress against actions

Auditor carry out follow ups until progress against actions is satisfactory: SDM/leader officers provide progress updates and supporting evidence

Auditor evaluates evidence, decides audit opinion and publishes follow up report; SDM/leader officers share with service

SIE monitor progress against outstanding actions and auditors carry out follow ups until complete

SIE report quarterly to ASCLT on audits completed/progress against actions/good practice identified

ASCLT review report and identify further actions if required; TLs cascade to service

Auditors meet quarterly with SIE to review progress and agree audit work plan; audit requests are informed by outcome of all QA activities in the service

Auditors report to senior leadership and scrutiny committee and publish reports

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External and partner audit e.g. External audit Adult Safeguarding Board CQC information sharing meetings Peer Challenge and Sector Led Improvement Ofsted Ad hoc as per individual schedules

Service participates as per agreed arrangements

Outcomes shared as appropriate

Learning Outcome Meetings Regular quarterly meetings Specific one off meetings

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Self-Evaluation Daily

Policies, procedures, guidance, standards etc

All staff providing services are responsible for making sure practice standards are met at all times

Practitioners reflect and self-evaluate as they go about their daily duties taking guidance from policy, procedure, job descriptions, professional regulation and corporate governance; they are responsible for ensuring their practice meets statutory requirements, professionals standards and service standards, and will seek advice where appropriate

Practitioners take corrective actions if needed and raise any issues with TL/Senior

Practitioners are responsible for meeting service recording standards, which they are aware of through training and guidance

All system users are responsible for taking action if they notice any recording errors or omissions or potential quality issues (remedy them self or notify appropriate practitioner or TL)

Supervision and management oversight Monthly/ Daily


Managers/ supervisors are responsible for considering quality assurance as part of their daily management and authorisation; they will also evaluate quality of practice and address and issues via supervision and CPD.

Managers/supervisors are responsible for escalating any significant concerns

Scrutiny built into systems Daily

Electronic client records contain authorisation pathways

Evaluation of recordings Daily


All system users System users identify any errors/ omissions/ issues and correct these or raise with practitioner/TL or supervisor TL cascade anything relevant System user/TL

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