From Requires Improvement to Good: How CHD Care at Home South West Surrey utilised technology to improve their CQC rating
July 9, 2021
Providing home care isn’t always smooth sailing. With so many moving parts, regulations to keep up with and constant daily fires to deal with, a 'Requires Improvement' rating is something that 12% of all home care providers receive. But it doesn’t have to stay that way. CHD Care at Home are proof that with the right processes, technology and attitude, a Requires Improvement rating can be the launchpad to success. As a result of a targeted CQC inspection, they’re out of their previous rating, ‘Requires Improvement’, and into ‘Good’. With technology cited throughout their inspection as a driving factor for their improvement, we reached out to Regional Manager, Rebecca Connolly, and Registered Manager, Paul Milton, to find out how they’d managed to increase their rating.
The problem with paper
Paper causes delays. And sometimes, these delays are enough to bring down your CQC rating. Rebecca told us that because they used to work on paper systems at CHD Care at Home, they’d struggle to monitor what was happening in people’s homes, sometimes not finding out about issues until a few days later.
Paul, who joined CHD Care at Home after the initial Requires Improvement rating was assigned, has, during his time in post as Registered Manager, managed to improve their rating and change the way that the team works. He explained:
“The problem with paper is that it's a waste of time. That piece of paper is only as current as when you print it. So we could print it all and it could change the next day. Now, the majority of our documentation is in Birdie, so when social services will ask for MAR Charts or care logs we’ll just download them and ping the PDF over. Before we had to scan it all in and email them. So even that process is a lot smoother without paper.”
Rebecca told us: “[At our last inspection] We got Requires Improvement in Well-Led and Safe, and that was due to missed calls, which meant that medications were being missed. That was a big thing, the not knowing. [Before Birdie] we’d be relying on someone from the branch to drive out to every client once a month, collect all that paperwork in and then audit all of that. When you have a whole month’s worth, for eighty clients, stuff’s going to get missed. And following up on things that may have happened three weeks ago - it just becomes impossible.”
A new way to audit
With the prospect of a Focused Inspection coming, two key lines of enquiry that required improvement and a global pandemic taking hold, CHD Care at Home realised they needed a solution.
That’s when they found Birdie. It may not seem ideal to implement software during a pandemic, but as Rebecca told us, “It was actually the perfect time to bring in new systems to help us.”
Since the team brought in Birdie, they’ve completely changed the way they audit. And missed calls? They’re a thing of the past. In Paul’s own words, “Birdie has drastically improved things.”
Rebecca told us: “Birdie helped so much with the alerts for medications, and the reporting too, that's really helped. With medication reporting, you can see instantly what’s happened. You can see the reasons why the medication wasn’t taken and there's this whole feedback loop. And we’re doing that daily - so we’re auditing in the moment, constantly with the alerts. And, we can evidence everything that’s happened, and importantly how it’s improved [since the last inspection].”
The CQC inspector agreed, citing their huge improvements throughout their latest report:
"Since our last inspection, the provider had implemented electronic systems for staff rostering and care planning. These systems enabled the office team to monitor call attendance and task completion in real-time."
"At this inspection, we found evidence of improvement. The electronic care planning system implemented by the provider recorded people's needs in relation to the medicines they took, which meant staff had access to the information they needed."
"The system also alerted the office team if people's medicines were not signed for 90 minutes after their care visit. In addition, the system generated weekly medicines audits and highlighted any errors."
"The medicines audits we checked demonstrated that people received their medicines safely. Where recording errors were identified, these had been investigated by the registered manager and appropriate action taken in response."
"At this inspection, we found evidence of improvement and the breach had been met. The electronic systems implemented by the provider had improved the ability of the office team to monitor the quality and safety of the service. This had led to improvements in the consistency of call times and the monitoring of medicines."
Paul explained: “Implementing Birdie means that our medication records are now live, and we can change anything at the drop of a hat if needed. It really improves the record-keeping too as, before Birdie, the carers would have to rummage for a bit of paper to sign. Now it's all on their phone in front of them, and it's become like second nature.”
He continued: “The biggest benefit is the real-time live communication from us to the staff and the staff to us. Whereas before there was a delay with MAR sheets and medication being added it’s now live, done there and then.”
Changing CQC expectations
CHD Care at Home’s latest inspection also marks a shift in CQC behaviour. Their inspector looked at everything live on the Birdie system during the inspection - which aligns with their new 2021 strategy - focusing on technology and how it can be utilised as a positive resource in home care.
Rebecca told us: “This inspector hadn't seen Birdie before. He'd seen Pass, but he really liked the [Birdie] system. He looked at everything live for us. He told us what he wanted to look at, like a client with a double-up and someone who has a patch medication. He sat with a client coordinator who knows the system inside out and went through everything there, on the system. Because we had 24 hours notice we knew the areas that we want to evidence, so we also got all that together in a draft email with things like a screenshot of our alerts and our reports that showed no missed calls or medication.”
Maximising the benefits
It’s not just CHD Care at Home’s CQC inspection that’s improved with Birdie. With the time saved by using Birdie combined with Birdie’s Family App function, they’ve implemented a brand new system called ‘Client of the Day’.
Rebecca explained how they’re using this new initiative to help them respond to the CQC’s focus on technology and feedback: “Designed to run alongside Birdie, Client of the Day means staff have one client each day that they look at [in-depth]. They phone that client or that client’s family member and get feedback - so we're touching base, all the time. And then we can see if there's anything on Birdie that we can change straight away. We put all the feedback we receive into a form, then we scan the documents into Birdie.”
She continued: “[The CQC] are very much about technology and feedback at the moment and because Birdie has the Family App, it means there’s that transparency. And when we do our calls for Client of the Day, the family members really love the fact they can look over everything. And especially through the pandemic, they’ve been able to visit and see exactly what's been going on too.”
And for Paul, as the Registered Manager, he told us that improving CHD Care at Home’s CQC rating means a number of benefits for the business. “It helps us with the Local Authorities, for one. Obviously, if we’re rated Requires Improvement, we're less desirable to award a package of care. [With a good Rating] they're less worried about the service that we're providing because they can see that we have a Good rating. It's also nicer for senior management teams to have that green [Good] rating across Care at Home. And, it's nice for me as well, to know that I can proudly say that I run a Good service.”