Outstanding overall at last

After coming a hairs breath to achieving Outstanding overall from CQC two years ago I’m delighted to see that Elizabeth Finn’s Rush Court have now achieved it, and retained their Outstanding KLOE’s in Caring and Responsive.

And it’s great to get a mention in the report too (Caring KLOE since you ask):

“The service continued to involve people and staff in the 'Ladder to the Moon' initiative. The purpose of the scheme was to promote an inclusive culture that ensured everyone felt part of the service and were valued and respected. The scheme is recognised as a good practice scheme that involves people, staff and the wider community in developing care that is person-centred and values each person as an individual.”


Continuous Improvement drives Outstanding Care

CQC Outstanding is full of references to continuous improvement in services, but in my experience very few organisations are doing this well. Intentional processes for continuous improvement rarely look beyond compliance, and where they do they are often missing out key elements. I think this is an area with significant potential for care organsiations, and have made some suggestions below.


We tend to see two scenarios; either improvement is limited to a narrow domain of compliance, or where there is attention given to the wider business performance, improvement initiatives tend to be ad-hoc, and reliant on a small number of individuals in the service, often those in senior positions.

There is a third scenario that some of our client partners are creating. One where continuous improvement is driven by what the organisation wants to achieve, not just what it wants to fix. Where ideas and opportunities come from all quarters of the organisation and its community. Where a diverse group of people are involved in creative problem solving to work out the best solutions. And where all of this is managed in a consistent, replicable way that isn’t reliant on one ‘star’ individual making it happen. And of course, all of it is easily evidenced to CQC.

As ever in care organisations making the third scenario is complicated. It isn’t just about the processes, it is the wider culture and climate of the organisation, the leadership and skills of the people involved. Process is never a solution on its own, but it is an important part of the picture.

If you want to develop a more holistic approach to continuous improvement, than I suggest asking yourself some of the following questions:

How to identify improvement opportunities across the business?
How to ensure the teams our focused on the core purpose and values of the organisation?
How to involve everyone in identifying opportunities, generating and selecting ideas and implementing them?
How to ensure this is happing on a regular basis?
How to record and evidence what is happening?

Do you have effective continuous improvement processes in place? If you do please share them. If you don’t we’d love to help.

Outstanding Responsive Care At Ashley Gardens

CQC have rated one of the homes we have been working with in-depth over the past two years as Outstanding in the responsive characteristic, and good overall.

The Ladder to the Moon work has greatly contributed to the Outstanding rating in responsive.
— Jo Mazza. Manager, Ashley Gardens

There are a number of direct references to our work together in the report:

"A team of activity co-ordinators were employed for the service who called themselves the 'Vibrancy team'. We spoke with two people from the team who told us that, when people are first admitted into the service a social and leisure plan is developed. This includes a detailed discussion with the person and their family recording the persons, likes, dislikes, hobbies and interests. People were involved in planning the activities they wanted to participate in on a monthly basis, which was recorded and displayed for people to access. 

At the time of our inspection there was a wall displaying wishes that people had made. We were told that this was the wishing wall and each person who wanted to participate had made a wish, which the 'Vibrancy team' and staff would help come true.... These wishes had been fulfilled with the support of staff and the 'Vibrancy team'. People and their relatives said that these had made people happy.

[They] receive support from a company [Ladder to the Moon] which provides workforce and service development, that enables health and care organisations to develop active, creative, vibrant care services. This project involved training members of the 'Vibrancy team' to embed new ways of working with people. The project also sends a box of different topics on a monthly basis... We observed people in a small group with one staff going through the items and talking about them. People were participating and engaged in the activity and they were smiling and chatty. People were happy to tell us about previous boxes they had received ... This meant that people were benefiting from activities they were interested in and enjoyed."


Ashley Gardens, had first worked with us on a long term culture change project, and have used our Outstanding Activities programme to sustain and maintain the positive effects. CQC have certainly recognised the impact.

Creative Leadership Workshop at National Dementia Congress

I'm running a workshop next Wednesday (4th Dec) at the National Dementia Congress along with  Neil Maiden and Alise Kirtley from The Centre for Creativity in Professional Practice at City University London and our own Shula Hawes.

Creativity is not a gift of a chosen few, but a skill that can be developed with the use of evidence-based techniques. In dementia care, creative thinking plays a pivotal role in being able to offer services of highest quality; from leadership and workforce development through to person-centred practice and positive risk taking. In fact, the Care Quality Commission states that creativity and innovation are key differentiators between Good and Outstanding adult social care services.

Creative Leaders at a recent conference for the orders of St. John Care Trust

Creative Leaders at a recent conference for the orders of St. John Care Trust

In this workshop, Ladder to the Moon and City University London will explain and contextualise creativity in care, in the light of CQC guidance. They will demonstrate how creativity and innovation can be put into practice, with reference to their own tools and the impact these have caused.  

In small groups, participants will then use different creativity techniques (from Ladder to the Moon and City University London, including the digital tools Care’n’ Share and BeCreative in Care) to develop new ideas for providing person-centred care. Groups will consider real-life scenarios and discuss case studies of creative and innovative practice, to fuel their own ideas and self-reflection.

A short closing presentation will emphasise key factors in successful use of creative and innovative approaches, as well as the challenges. Participants will also be signposted to the resources that are available to support creative and innovative practice.

Who should attend:

This workshop will be of interest to care service owners, care commissioners, care practitioners, carers and people living with dementia.

Participants will gain:

  • Understanding of the role creativity and innovation in care, including how it can look in practice, the outcomes it can deliver and how it corresponds to CQC guidance.
  • A number of creative approaches to care challenges, as explored by the attendees together in the session, guided by an expert in creative thinking techniques.

Hope to see you there!


CQC Links and our surge towards Outstanding Services

I had a surprise phone call last week. For the first time that I can remember a home owner called me up out of the blue. It’s usually me going out to them - talking, presenting, calling and care show’s. But this time I was called, and the reason the for the call was that the home just down the street had their CQC report published.

The home in question - Rush Court, operated by one of our Clients Elizabeth Finn, were Outstanding in two area’s and a hairs breath from Outstanding overall. The reason he called Ladder to the Moon was that there were three big paragraphs on the work that they had been doing with us.

the registered manager told us of the positive effects on staff engagement [Ladder to the Moon] had. 

This was how CQC described us 

The purpose of the scheme is to motivate and inspire staff to provide individualised care that was kind and compassionate. The scheme is recognised as a good practice scheme that involves people, staff and the wider community in developing personalised care. 

So what did we do? Our approach is to work on multiple levels with a service (and often Head Office). We work with senior teams on leading for creativity and innovation in line with CQC Outstanding. We focus on developing projects owned by the team in the service to motivate and inspire a creative culture of care.

One of the key places we work is with activity staff to involve and engage colleagues, relatives, friends family and the wider community in a way that makes a meaningful difference to quality of life. Often this involves using events in a slightly different way:

Staff spoke passionately about [Ladder to the Moon] and showed us photographs of monthly themed evenings where people and staff enjoyed time together. All staff were invited to the evenings, this included housekeeping, catering, maintenance and office staff. One member of staff told us, "I come in on my day off for them. Last night we had a cheese and wine party". We heard a person chatting to a care worker about the evening and both had obviously enjoyed the shared experience

We have a strong emphasis on working with the most isolated individuals in a service and transforming their experience.

A small example from the team last week was Mary a resident in a nursing home who normally was ‘brought’ to the breakfast room at the start of the day to eat, and then fell asleep in her chair in the dinning room until it was time to for lunch, at which point she was woken up and fed. Supported by out Outstanding Activities programme, Karen, the activity coordinator used a creative activity box, and the savouring skills she developed during training to engage Mary in a photo shoot. Much to everyones surprise Mary was alert and enjoying herself.

This is important, not only for the improvement in Mary’s quality of life, but also because of the message that it send to everyone who see’s Mary smiling, and everyone who’s then talking about that moment, about what is possible with the right engagement.

As the manager at Rush Court is quoted in the CQC report our programme is about

”Making sure everything we do is about the people who live here"

You can read the full report here CQC report from Rush court

I’m looking forward to more phone calls from operators who want their services to be Outstanding.

Ladder to the Moon in Journal of Dementia Care

Chris Gage's article discusses the future of care

The July/August 2014 issue of Journal of Dementia care included a full-length feature on Ladder to the Moon’s vision for a vibrant future in care settings.

The article reviews current trends in activities provision, with a focus on participative arts. The article then considers challenges to change, and the role of creative leadership in overcoming these.

It’s an inspiring read with lots of examples from our own work and across the sector- do take a look and share. You download it directly by clicking here