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.