Nominated as Responsible · 2018-04-03 · Work with your organisation to define the parameters of the role ... The overall direction of travel in the social care sector is towards

Nominated as Responsible A Handbook for Nominated Individuals in registered adult social care services in England

“The aim of the National Skills Academy for Social Care is to strengthen leadership across the sector. Nominated Individuals play a pivotal leadership role in registered services. This Handbook is for them, to help clarify what good leadership looks like and to show how it can be attained through everyday behaviours. And high quality leadership means high quality services.”Debbie Sorkin, Chief Executive, National Skills Academy for Social Care

2 3Contents Contents

Contents

Introduction 4 Welcome to this Handbook

Background 6 Key research findings that underpin this handbook

Ten Advisory Guidelines for Nominated Individuals 10

Guideline 1 12 Know and understand the laws, regulations,

standards and guidance associated with the role

Guideline 2 18 Provide an effective contact point for CQC

Guideline 3 24 Work with your organisation to define the parameters of the role

Guideline 4 30 Ensure Registered Managers have professional supervision

Guideline 5 36 Keep a focus on the quality of life of the service users

Guideline 6 42 Establish a systematic approach to supervision

Guideline 7 48 Build and maintain external relationships

Guideline 8 52 Offer leadership in shaping service culture

Guideline 9 56 Network and learn with other Nominated Individuals

Guideline 10 62 Champion excellence within your organisation

Defining the Role 66 An exemplar Job Description for a Nominated Individual

About the Skills Academy 68

Special Thanks 70

5 Introduction

IntroductionWelcome to this HandbookWelcome to this Guide for Nominated Individuals working in adult social care services. Nominated Individuals hold a pivotal leadership role in their services. They have overall responsibility for supervising the management of the regulated service and for ensuring the quality of the services provided. We know from research carried out by the Skills Academy1 that over 90% of providers see a direct link between the level of leadership and the level of quality in a service. So the quality of the services provided in your organisation is, in a very real sense, down to the leadership you show in your role as Nominated Individual.

The National Skills Academy for Social Care, with its core remit to strengthen leadership at all levels in the sector, has therefore worked in partnership with CPEA Ltd and Care Management Group to produce a Guide in order to illustrate, in a practical and accessible way, how Nominated Individuals can fulfil their leadership role and ensure the quality of their services.

We have based the Guide on extensive consultation, including a research survey that asked Nominated Individuals and those working with them about their roles; how they fulfilled them; and what kinds of support would be valuable to them. So the Guide is framed in terms of what ultimately matters to you: providing high quality support for people using care and support services, so that they can realise independence, exercise meaningful choice and control, and live with dignity and opportunity. We have also put the emphasis on clarity and plain English, providing an over-arching view on what good practice looks like in different aspects of the role, whilst signposting you to sources of more detailed information.

Good social care has the potential to transform people’s lives. We believe that this is what Nominated Individuals in social care aspire to do. So we hope that this Guide can become an essential source of support for you, so that the vision we all share for social care can become a reality.

Jo Cleary

Chair, National Skills Academy for Social Care

1 National Skills Academy for Social Care (2012) Who Cares? A research report into how the care sector’s reputation, approach to leadership and organisations are perceived by those who work in it. NSA, London.

7 Background

Background Regulations in social care require identified regulated service providers – organisations and companies - to nominate an individual to act as the main point of contact with the Care Quality Commission (CQC). A duly Nominated Individual has overall responsibility for supervising the management of the regulated activity, and ensuring the quality of the services provided.

In practice, not only is there a wide range of roles from which Nominated Individuals are drawn; there appears to be a broad spectrum of understanding about what the role actually entails.

Although there are a number of quality frameworks in existence in social care, there has been little specific guidance to date about how Nominated Individuals should perform their role or what they should be looking for in the services for which they hold responsibility. There is limited guidance to Boards about how they should be holding Nominated Individuals to account and assuring themselves of their fitness for the role.

The overall direction of travel in the social care sector is towards greater accountability and transparency, along with a commitment to service quality. In support of this, the Department of Health, with CQC support, commissioned the National Skills Academy for Social Care to prepare guidance and resources to help Nominated Individuals and the Boards of the organisations they work for to understand their role. As a starting point, the National Skills Academy commissioned a survey among people undertaking the role of Nominated Individual, followed up by a workshop and one-to-one interviews.

The research explored the induction people had when they started out; how they viewed the role; what they saw as the key components and the most important aspects of it; the level of support and training they currently received; and what kinds of support they believed would have a tangible impact.

8 9 BackgroundBackground

Key findings of the researchThe survey attracted over 400 responses from across social care organisations, with the overall findings covering four main areas:

+ Taking the responsibility seriouslyResponsible Individuals2 took their responsibilities seriously. They understood the importance of the role and the breadth of the tasks associated with it. The words the Responsible Individuals themselves associated with the role demonstrate this, with ‘accountable’, ‘leader’, ‘professional’, knowledgeable’ and

‘customer-focused’ being commonly cited. However, this needed to be more fully reciprocated across the sector. It was felt that there was insufficient appreciation in the sector generally of the role and what it entails, and there needed to be better induction for Responsible Individuals as a matter of course, instead of the experience of over half the respondents who had either learned

‘on the job’ or received no induction at all.

+ Clarifying the responsibilityWhen asked to describe their role, Responsible Individuals came up with an enormous range of responses. Some of these focused on quality and person-centred care, but others varied across staff management and disciplinary issues all the way through to regulation and inspection. This may well be a corollary of the role being insufficiently understood in the sector: having greater clarity, with consistent statements from the regulator and from other sector bodies about the role and its focus on service quality, would help define the role better for those involved. It might also alleviate some of the time pressures to which so many Responsible Individuals alluded.

+ Focusing on development Responsible Individuals saw that they had a primary role in developing continuous improvement in their services, especially as they related to improving the experience of people using care and support services. At the same time, there was some evidence that although Responsible Individuals were undertaking training and development, and although employers were committed to investing in this area, there was concern that the programmes available were not focusing on their needs. Programmes aimed at the specific requirements of the role, and clarifying the expectations around the role, would be helpful for the Responsible Individual and their employer.

+ Supporting the roleAt the same time, there was clear support for the idea of better guidance, both via the regulator and via a handbook focusing on the key issues, alongside recognition of the value that networking can bring in terms of peer support and sharing information. These might be the most realistic forms of help and support in the face of sector-wide issues to which there are no easy or instant solutions. CQC, in its role as regulator and inspector, could also help by providing greater clarity about the role on its website.

The detailed results of the survey are available in a separate document3 that can be read alongside the Guide. The survey provided a clear evidence base for the need for better guidance and information. The next sections of this handbook therefore set out this guidance and information in more detail.

2 The survey used the term Responsible Individual rather than Nominated Individual as it is widely used in the sector and is inclusive of people registered as appropriate persons (sole traders or partnerships) as well as those nominated by public bodies, companies and charities.

3 National Skills Academy for Social Care (2014) Responsible Leadership: A research report into how Responsible Individuals in registered social care services view their role, and the support and guidance that they would find helpful. NSA, London.

10 Background

Ten Advisory Guidelines for Nominated Individuals In response to the research finding that Nominated Individuals would welcome a practical and helpful handbook, we have set out our guidance in ten key points. The first three points are about knowing why the role is required. They are followed by five points about supervising the management of the regulated activity, and then a final two points that focus on continuous professional and personal development, and on the ambassadorial role that many leaders perform. Each point focuses on different aspects of the type of leadership and management activities that a Nominated Individual might be expected to undertake. Where appropriate, they include comments from Nominated Individuals about what this means in practice to them, and how they go about the business of fulfilling the role.

Ten Advisory Guidelines

+ Know and understand the laws, regulations, standards and guidance associated with the role

+ Provide an effective contact point for CQC

+ Work with your organisation to define the parameters of the role

+ Ensure Registered Managers have professional supervision

+ Keep a focus on the quality of life of the service users

+ Establish a systematic approach to supervision

+ Build and maintain external relationships

+ Offer leadership in shaping service culture

+ Network and learn with other Nominated Individuals

+ Champion excellence within your organisation

13

Guideline 1: Know and understand the laws, regulations, standards and guidance associated with the role

Guideline 1

Guideline 1 Guideline 114 15

1.1 What is a Nominated Individual? Outcomes 22 and 23 of the Essential Standards of Quality and Safety have the respective regulations for when the provider is an individual or partnership and when it is a body other than this (i.e. public body, company or charity). Each Outcome includes a description of what people who use services should experience and has prompts for providers to consider.

The regulations require identified regulated4 service providers to nominate an individual to act as the main point of contact with the Care Quality Commission (CQC). A Nominated Individual has responsibility for supervising the management of the regulated activity, so they should have the necessary expertise to be able to do so. They should be an employed director, manager or secretary of the organisation. It is up to the provider who to nominate, as long as they meet these criteria.

A Nominated Individual can cover all or several of the regulated activities provided. If the provider wishes it can have a different individual for each regulated activity. In registering, the provider is asked to state on the application form which regulated activities each Nominated Individual will be responsible for.

The Nominated Individual and Registered Manager can be the same person.

An individual or partnership registering does not need a Nominated Individual. This is the case with many smaller businesses. The requirement relates to organisations and companies and that person is named on their behalf as the main point of contact for CQC.

There are similar requirements in all parts of the UK and in a number of aspects of children’s services5. Whilst it is a fact that the same person may perform the equivalent role across countries and in both adult and children’s services: this guidance from the National Skills Academy for Social Care is about adult social care arrangements in England.

4 What is registration? See http://www.cqc.org.uk/organisations-we-regulate/registering-first-time/what-registration 5 For information about regulation of children’s services in Englan http://www.ofsted.gov.uk/children-and-families-services/for-children-and-families-services-providers/regulating-children-and-families-services

6 Fit and proper persons test see: https://www.gov.uk/government/consultations/fit-and-proper-persons-test-regulations

A note on related terminology

• Appropriate person: this is used where the registered service provider is an individual or partnership. It usually refers to the owner who may also be the Registered Manager.

• Responsible individual or person: commonly used to refer to both the responsibilities of an appropriate person and Nominated Individual. That is people with statutory responsibilities for supervising the management of the carrying on of the regulated activity. Whilst this guidance is written for Nominated Individuals, most of it is applicable to people who are registered individually as appropriate providers or persons. The term Responsible Individual does not feature in CQC regulation and standards but it is in common usage in the sector and the National Skills Academy survey used it to be inclusive of all types of ownership.

• Fit person: sometimes used to describe a person who has the met the criteria to be a Registered Provider (as an individual or part of a partnership), or a Nominated Individual or Registered Manager. This is about character, physical and mental ability, qualifications, knowledge, skills and experience as well as having been the subject of the necessary checks. It is not a role as such, and nor is it currently used in CQC regulation and standards, but the concept of becoming a ‘fit person’ is familiar to the sector. Consultations are underway about introducing a ‘fit and proper persons’ test6.


1.3 The legal background The Health and Social Care Act 2008 and the subsequent Regulations in 2010 are the basis for regulated activity in health and social care in England. This legislation specifies the criteria for Nominated Individuals and lays out the requirements for the type of organisation that must put them in place.

Regulations define ‘organisations’ as including: local authorities, NHS trusts, voluntary organisations, charities, limited companies and limited liability partnerships.

To appoint someone as a Nominated Individual, an organisation must be able to show that the person:

• has a clear check from the Disclosure and Barring Service

• is employed by the organisation as a director, manager or secretary with responsibility to supervise the management of the regulated activity

• has the necessary ability to carry out the supervisory role.

1.4 Role and responsibilityOrganisations and companies providing regulated activities are required to have a Registered Manager and a Nominated Individual; they have different, but interlinked roles. They can be, but are not usually, the same person. The Registered Manager has to manage the provision of a safe, effective, high quality service and the Nominated Individual has to supervise, and take responsibility for, the management and provision of the service.

19

Guideline 2: Provide an effective contact point for CQC

Guideline 2


The Nominated Individual holds a key role for any registered service. The role is fundamentally about being the contact person for the Care Quality Commission (CQC); but it so much more than just that. It is not a passive point of contact or ‘postbox’ role. The person in the position will be held to account by CQC for the quality and safety of the service. The organisation will have to be able to demonstrate that the Nominated Individual is capable of performing this role and that they have the relevant skills, knowledge and experience to oversee the carrying on of a regulated service.

As the main point of contact for the CQC the position-holder should be able to respond to requests for information and queries; this means that the Nominated Individual must always have current and accurate knowledge of the service at any given point.

2.1 What does the Nominated Individual do as main point of contact?

+ makes sure the registration details are accurate and up to date both in the service and with CQC

+ ensures CQC are notified of any changes to registration details and that they receive other notifications as required in the regulations

+ receives copies of all information and reports in respect of inspections

+ is involved in the oversight of inspection arrangements – knowing what is happening where and when

+ develops a business relationship with CQC – either personally or through an arrangement that is a direct report

+ Is available to ‘troubleshoot’ for the organisation.

Guideline 223

A Director of Nursing for a large mental health provider was the contact point for all communications during a large scale investigation. This included not only CQC, but the local authority, the clinical commissioning group and individual commissioners.

The revised CQC Inspection Framework, A Fresh Start, is constructed around five key questions about a service:

+ Is it safe?+ Is it effective?+ Is it caring?+ Is it responsive?

+ Is it well-led?

A Nominated Individual must be able to know the extent to which their service can evidence their achievement of each of these, and will make a direct contribution to answering the question about how well led the service is.

The government and CQC have made it clear that they are going to strengthen accountability for the quality of services; this will particularly impact on Nominated Individuals as they are ultimately held to account for the quality of the service that is delivered.

Where serious failures occur in services, it is not just owners and Registered Managers who are subject of criminal proceedings; the Nominated Individual is also held to account through the courts.

Nominated Individuals have a vitally important role in the oversight and development of a regulated service. In a survey of Nominated Individuals commissioned by The National Skills Academy for Social Care, ‘leadership’, along with ‘accountability’ and ‘responsibility’ were the words that Nominated Individuals most associated with their role. Clearly, leadership of services is not only what Chief Executives do.

I have a role around contentious admissions and giving customers notice. This is important as it makes sure safety and care issues are put ahead of those of income. There are pressures to admit people and not to give people notice to quit. The role is to make sure we keep to our stated purpose and are resourced to do so.

25

Guideline 3: Work with your organisation to define the parameters of the role

Guideline 3

Guideline 326

The key roles in regulation are being the point of contact and supervising the management of the regulated activity. It is helpful if the expectations associated with these are laid out in more detail in a role specification at the point of nomination of an individual. Such a specification should say both what is expected of the role holder and what the organisation will do by way of support.

A key expectation is to ensure that there are adequate numbers of staff in place, that the necessary resources and equipment are in place, that the staff are sufficiently trained and that vulnerable people are safe from harm and abuse. Ultimately, a failure in any of these areas will be the responsibility of the Nominated Individual as well as the organisation.

The requirement to supervise the management of the regulated service means that people in the role must have strong leadership and communication skills and the ability to work effectively in partnership with the Registered Manager. Depending on the structure of the organisation, the Nominated Individual may provide the communication channel between the owner or the Board and the Registered Manager.

An exemplar Job Description is set out later in this handbook.

It is important that the Nominated Individual has an appropriate position in the organisation – in my case it is clear that I have direct access to the Chief Executive and Chair of the Board of Trustees if need be. I am a sort of ‘whistleblower-in-chief’. I expect access to be immediate if it is necessary.

Section Section28 29

Supervising the Management of the service. The next five guidelines are all about supervising the management of the regulated activity. + Ensure Registered Managers have

professional supervision

+ Keep a focus on the quality of life of the service users

+ Establish a systematic approach to supervision

+ Build and maintain external relationships

+ Offer leadership in shaping service culture

31

Guideline 4: Ensure Registered Managers have professional supervision

Guideline 4


Professional or clinical supervision is the regular contact between a supervisor and a Registered Manager in which to monitor and reflect on practice; review and prioritise work, provide guidance and support and identify areas of professional development. It is an accountable, two-way process that supports, motivates and enables the development of good practice for individual Registered Managers. As a result, good professional/clinical supervision improves the quality of service provided by the organisation.

Professional/clinical supervision differs from Management Supervision, which holds managers to account for the services they deliver, but also offers the opportunity for review and personal and service development planning. Management supervision enables the Nominated Individual to discuss all aspects of the services and is one of the ways to be assured that services are being delivered to a good quality standard. This type of supervision should also provide information about a range of indicators that may indicate areas of possible concern such as high sickness levels, high staff turnover and an increase in complaints.

“As well as giving people space to reflect it’s important to keep a focus on service quality. Things that we have found work are making sure that every service in every line managers portfolio gets discussed at every supervision making sure line managers dig into the detail and not just take peoples word for thing, hence show me the evidence.”

Professional or clinical supervision is essential not only for Registered Managers, but other line managers and senior managers also need the benefits of supervision.

The Nominated Individual may not able to offer professional supervision personally, either because of other demands, or because they do not have the necessary professional experience. A mentor, a clinical supervisor or a trained peer can provide professional supervision, it may be necessary to purchase these services if there is no-one within the organisation with the professional competence to provide it.

One owner of three homes said he visited each regularly but made sure his Registered Managers received professional supervision from a qualified nurse working under contract for service support.

Supervision: an accountable process which supports, assures and develops the knowledge skills and values of an individual group or team. Skills for Care 2007


Supervision is usually one-to-one, but it can be with a small group of peers. For example, if an organisation has several Registered Managers in a locality, group supervision may be useful. However, people should still be offered the opportunity for one-to-one supervision in case there are personal, confidential issues they wish to discuss.

• supervision should take place monthly, or at the most, six weekly

• it is a time that should be very clearly in the diary and should be a priority commitment that is only postponed in exceptional circumstances

• supervision should last about 1.5 hrs

• both supervisors and supervisees should prepare for the session by going through previous notes and preparing any issues that need to be raised

• generally, the contents of professional/clinical supervision are confidential unless concerns about a supervisee’s competence, physical or mental health become evident

• the supervisor should record the areas discussed, the outcomes agreed and any goals/targets to be reviewed. The record should also be signed by the supervisee

• it is good practice for a supervision ‘contract’ to be in place between supervisor and supervisee setting out matters such as frequency, time, expectations and confidentiality.

Further informationA research paper Effective Supervision in Social Work and Social Care. SCIE 2012 http://www.scie.org.uk/publications/briefings/files/briefing43.pdf

Providing effective supervision; a workforce development tool to support professional supervision http://www.skillsforcare.org.uk/Document-library/Finding-and-keeping-workers/Supervision/Providing-Effective-Supervision.pdf

Guidance on Clinical or professional supervision from CQC published following the Winterbourne View Hospital enquiry http://www.cqc.org.uk/sites/default/files/media documents/ 20130625_800734_v1_00_supporting_information-effective_clinical_supervision_for_publication.pdf

Section Section Name36 37

Guideline 5: Keep a focus on the quality of life of the service users

Guideline 5


The Statement of Purpose is about more than simply complying with registration requirements by providing a few words about the service. This should reflect what the service is intending to achieve, why it exists and what it offers. It should also be what drives the business and forms the basis for strategic and operational planning. All elements of business planning should relate back to the aims and objectives outlined in the Statement of Purpose.

Nominated Individuals can use the Statement of Purpose as the basis for measuring that the service is providing what it should be. The most important aspect of what any service provides is the quality of life for the people who use it. Regardless of whether people using services live in the community or in a residential setting, the service should be able to show that it has improved the quality of life for the people who use it.

The role of a Nominated Individual in supervising the management of service provision is about much more than just making sure that all of the CQC requirements are met. It is about ensuring that the systems and processes enable the service to feel confident that it is achieving well and providing a high quality service.

There are various tools for checking on quality of life provided. One of the best known is the ASCOT (Adult Social Care Outcomes Tool), developed by the Personal Social Services Research Unit (PSSRU) at the University of Kent. It uses measures ranging from Accommodation, Cleanliness and Comfort to Social Participation and Involvement. It also explores key issues like the level of control people have over their daily lives and how people are affected by support and care.

There are other frameworks that are based on measuring against a set of standards. These cover a range of standards relating to provision and, through an inspection process, judgements are made about the extent to which a provider meets the standards. The Health and Social Care Act 2012 gave a new role to the National Institute for Health and Care Excellence (NICE) to develop guidelines and quality standards for social care, in addition to those they already produce for healthcare. The Senses Framework, developed by Sheffield Hallam University, proposes that senses play a significant part in creating an ‘enriched’ care environment for residents, staff and family. The six elements of this framework are sense of: security; continuity; belonging; purpose; achievement; and significance.

My Home Life, originally developed by the National Care Forum and Help the Aged in 2006, has eight key themes and has developed into an active movement promoting quality in care homes. There are also tools and frameworks specific to home care and to specialist areas of provision such as end of life care and dementia care.

Guideline 541

Further informationPersonal Social Services Research Unit ASCOT Framework provides a range of domains as a basis for measuring the quality of life of people using your service http://www.pssru.ac.uk/ascot/domains.php

My Home Life: began as a project and has now become a movement to improve the quality of residential care. http://myhomelife.org.uk/research/8-key-themes/

National Skills Academy for Social Care The Governance Toolkit. A useful e-learning programme for directors, trustees and owners with responsibility for governance https://www.nsasocialcare.co.uk/programmes/governance-for-adult-social-care

NICE has the responsibility for developing standards for health and social care http://www.nice.org.uk/guidance/qualitystandards/socialcare/home.jsp

“I visit 10 services every week to keep an eye on their quality and also to promote visibility. I keep a record of every visit I make. I have a mental checklist of things to look out for including:

I chat separately to service users and to staff. I enquire as to what activities have taken place and/or are planned that day and I also regularly sit down and read daily diaries which I find give a very good indication of quality of life for the service users.”

Staff morale

The

condition

of the

environment

Staff service user interaction


Guideline 6: Establish a systematic approach to supervision

Guideline 6


A guide from Think Local Act Personal, Driving up Quality in Adult Social Care, identifies three overarching factors that represent quality in services:

+ the individual experience of people receiving care and support and their personal expectations and outcomes

+ services which keep people safe through recognised standards, safeguards and the adoption of good practice

+ the recognised processes that ensure the effectiveness of services including their value for money.

The first of these factors was explored in the previous section and every organisation, regardless of size, has systems and processes. If these are effective and recording the right things, they can provide much of the information a Nominated Individual needs to ensure that the organisation is safe and working well.

Internal systems can provide key information such as:

• Staff learning and development

• Frequency of staff supervision

• Staff turnover

• Sickness levels

• Levels of participation in activity

• Numbers of service users self medicating

• Complaints

• Safeguarding alerts

• Health and safety inspection reports

• Fire safety inspections

• Food hygiene inspections

Each of these can provide valuable information about the service and any areas that may need closer observation. For example, a service with a very low % of service users self-medicating may indicate a need to review staff development in relation to the principles of choice and control and risk enablement. High levels of sickness and staff turnover may indicate recruitment concerns or an issue with staff morale that needs further investigation.

Poor inspections for health and safety or food hygiene identifies learning and development issues, but may also be highlighting issues with organisational culture and staff attitudes.

“I am the final arbiter for adverse DBS checks (in collaboration with HR). It is an expectation that I am consulted if there are decisions to be made.”

47 Guideline 6

It is important for the Nominated Individual to decide on a dataset that will provide sufficient information to highlight any potential problems and to ensure that this is made available at agreed intervals.

Further informationThink Local Act Personal (2012) Driving up Quality in Adult Social Care provides an overarching view of the principles required for a Quality Framework. http://www.thinklocalactpersonal.org.uk/Latest/Resource/?cid=9407

I receive and read all inspection reports. I send an email to the Registered Manager every time either congratulating them on a good report or asking if they are taking action to address any shortcomings identified. Where shortcomings are identified I print off a copy of the report and put it in the Operations Director’s supervision file. I subsequently checks with her in supervision that the issues are being addressed.


Guideline 7: Build and maintain external relationships

Guideline 7


All services have to maintain relationships with people outside of the organisation. These can include:

+ Families

+ Commissioners

+ Professional bodies

+ Regulators

+ Community organisations

A key role for the Nominated Individual is to supervise these relationships and to make sure that they are working well.

Families can often find it difficult to relate to providers, especially if the service is replacing some, or all, of their own care and support. The feelings of guilt and sense of failure that some families feel at having to call on professional support can be evidenced in challenge and an unwillingness to engage with the provider.

Alternatively some families are able to welcome the additional support of a provider but still recognise the importance of their own role. Checking that families are not excluded and that they participate as fully as they wish to in the care and support of their loved one should be high on the agenda of the Nominated Individual.

Commissioners are no longer just the local authority: increasingly, with greater integration of health and social care, they include health commissioners from Clinical Commissioning Groups or Continuing Health Care. There are significant and increasing numbers of self-funders commissioning their own support at home and a growth area is people choosing their own services using public funding. This will develop further over the next few years as government has signalled the intention to roll out the current pilots of purchasing residential services using personal budgets.

The Nominated Individual is much more than a point of contact, they are the person able to develop relationships and participate in partnerships and joint working. The ‘public face’ of the organisation is an important role in an increasingly commercial market.

Effective marketing is informed by market intelligence, much of which comes from being actively involved in linking to the local community, working in partnership with commissioners and ensuring the regulators have regular and current information.

The Registered Manager may value support in some challenging situations or difficult meetings and the Nominated Individual can provide an important addition to the strategic element of the organisation.


Guideline 8: Offer leadership in shaping service culture

Guideline 8


The saying that ‘Culture eats strategy for breakfast’7 is one most people have heard. It is true to a great extent, particularly in businesses such as social care that involve people in both using and delivering the service.

It is absolutely vital to any social care organisation that the service culture is based on clear values such as dignity, respect, valuing diversity and respecting people as individuals. Services should be grounded in compassion and caring and those qualities come from the leadership. A well-led organisation will have zero tolerance of poor care or any lack of concern for the welfare and happiness of the service users.

The National Skills Academy for Social Care has developed a Leadership Qualities Framework (LQF) that identifies the essential qualities that make an effective leader. In the recent survey, many Nominated Individuals identified leadership as one of their roles such that all dimensions of the LQF at the strategic level are of relevance. Organisations should have a culture of openness; it should be ready to learn and seek to learn from all experiences. Feedback and challenge should be welcomed and sought out, not rejected or dismissed.

Organisations that deliver services defensively and develop systems that are designed to protect the organisation rather than expose it to learning will never develop safe, high quality, compassionate services. A culture from the top that is concerned with looking inward and rejecting any challenge or criticism will result in a service that fails to move on and develop.

Driving up Quality in Adult Social Care has a self assessment tool that is useful in assessing the openness of an organisation and its willingness to learn from looking at how it is seen by those who use it and how it presents itself.

8 Attributed to Peter Drucker

The LQF identifies good leadership at a strategic level across each dimension and element as:

Dimension Element

Demonstrating personal qualities

Developing self awareness Managing yourself Continuing personal development Acting with integrity

Working with others Developing networks Building and maintaining relationships Encouraging contribution Working within teams

Managing services Planning Managing resources Managing people Managing performance

Improving services Ensuring the safety of people who use services Critically evaluating Encouraging improvement and innovation Facilitating transformation

Setting direction Identifying the contexts for change Making decisions Applying knowledge and evidence Evaluating impact

Creating the vision Developing the vision Communicating the vision Influencing the vision of the wider health and social care system Embodying the vision

Delivering the strategy Framing the strategy Developing the strategy Implementing the strategy Embedding the strategy


Guideline 9: Network and learn with other Nominated Individuals

Guideline 9


9.1 Continuing learning and developmentThere is a strong commitment to learning and development among Nominated Individuals and in the survey response they suggested a range of options for useful ways in which they could be supported.

There was a widespread support for a guide. This would provide a quick and easy reference point for Nominated Individuals with authoritative information and guidance around all aspects of their responsibilities.

Possible support from specialist advisers was welcomed by most Nominated Individuals, this could be combined with local networking events where specialist advisers could be accessed and information and learning shared. The National Skills Academy has supported the provision of local networks for Registered Managers that have been welcomed and well attended. It could usefully do similar for Nominated Individuals.

9.2 Resources

9.2.1 Leadership Qualities FrameworkThere are some existing resources to support learning and development that can be useful for Nominated Individuals. These include the Leadership Qualities Framework (LQF), so many Nominated Individuals identified leadership as one of their roles that all dimensions of the LQF at the Strategic level can be valuable as a way for individuals and organisations to build learning and development plans for Nominated Individuals. The National Skills Academy also has an assessment framework for the LQF. This is the Organisational Leadership Assessment Framework (OLAF) and it may be that organisations can include their Nominated Individual when they are assessing leadership within the organisation.

9.2.2 National Occupational StandardsThere are National Occupational Standards (NOS) that have been developed for Trustees. Although the responsibilities of a Trustee and a Nominated Individual are not the same, the functions of the roles share many similarities and the NOS may provide a useful structure for some organisations to include their Nominated Individual in any learning and development opportunities that are provided for their Trustees.

The units of the NOS are:

• safeguard and promote the values and mission

• determine the strategy and structure

• be effective, responsible and accountable

• make sure that the Board of Trustees functions effectively.

9.2.3 Governance FrameworkThe National Skills Academy has developed a Governance Framework and associated learning materials. Although aimed at Directors and Trustees, there are learning modules that will be relevant for Nominated Individuals. The e-learning modules cover:

• legislation

• values of social care

• good business practice

• regulatory compliance

• using financial information.

“There should be a common induction for Nominated Individuals which, among other things, shares what we know about gaining and securing access to get things done in organisations.”


9.3 Other sources of learning and guidanceThe Institute of Directors offer a wide range of courses covering the various roles and skills required for directors. The Director’s Knowledge Toolkit provides self assessment and a diagnostic covering four key areas; governance, strategy, finance and leadership. Courses cover the roles of the various board members and there are courses in specific skills such as chairing effective meetings, strategic thinking, use of social media, negotiating skills and inspirational leadership.

The Charity Commission provide guidance on their website about the operation of a charity and about the roles of a trustee, their responsibilities, how trustees make decisions and the limitations and restrictions for trustees.

Companies House provides a wide range of guidance documents concerning the operation and governance of companies. Including how to start a company, different types of companies, what documents and accounts need to be filed and when and how to search for information about any company registered in the UK.

Further informationNational Occupational Standards for Trustees http://cvsc.org.uk/wp-content/uploads/2009/08/NOS-for-Trustees-ENGLISH.pdf

Institute of Directors http://www.iod.com/developing/courses

The Charity Commission has information about trustees http://www.charitycommission.gov.uk/trustees-staff-and-volunteers/trustee-role/becoming-a-trustee/

Companies House http://www.companieshouse.gov.uk/


Guideline 10: Champion excellence within your organisation

Guideline10

Guideline 1064

The Nominated Individual needs to be visible. It is important that people know who the Nominated Individual is. People need to know how to find you and how to speak to you. Listening is as important as talking and the Nominated Individual can learn a great deal about their organisation by being out and about, making links and meeting the people who interact on any level with their organisation.

“In my view it should be possible to visit all services personally at least once per year and to attend all formal meetings of groups of Registered Managers (as Chair?).”

Being aware of any issues within an organisation will help the Nominated Individual to know what steps are being taken to address them and enable that information to be shared.

“Induction of Registered Managers is important and I expect to have a role that involves me in meeting them all face-to-face.” The workforce needs to know that they are valued and achievements should be recognised publicly within and outside the organisation. Everyone enjoys compliments and they should be the response to successes by staff. Celebration is an indispensable part of life - whether it is a resident’s 100th birthday, a positive inspection report or a good practice accolade the Nominated Individual should participate.

Visibility is about publicity. That means understanding that taking on the role of Nominated Individual is being an ambassador – for regulated social care, for your organisation and essentially for the people who make use of the services. It is important to keep the public informed of both the potential benefits and harms in providing a personalised social care services. It is vital to make sure that your organisation is widely recognised and valued for the work it does. And lastly it may be necessary to be visibly there for users of services to turn to should they have nowhere else to go.

I make sure information is made available to service users, staff and families about how to raise concerns. For example; that is regularly covered in a quarterly newsletter to all families. I make a point of being very visible attending service user and relative meetings and staff induction courses regularly so that people know who I am.

Section Section Name Defining the Role66 67

1. The Nominated Individual (NI) is the main point of contact between the Company and CQC. It is their responsibility to ensure the standards are met and regulations complied with. The NI must have a working knowledge of the regulations and standards, and work with Senior Management Team. Key responsibilities include:

• Visiting homes/services to do monthly quality monitoring.

• Interviewing, with consent and in private, individual services users and representatives (if applicable) and staff present on shift, in order to form an opinion of the standard of care in the home. Inspect the premises of the home, various records of events and any complaints records. Preparing a written report on the conduct of the home and upon request submit these to CQC and Area Managers, Operations Managers and Directors in accordance with notification of the Essential Standards.

• Reviewing and assessing the implementation by Area Managers of ‘for action items’ within timescales and Action Plans requested by the Quality Manager (QM) following previous inspection(s).

2. The NI is permitted to delegate visiting and inspection responsibilities to an appropriately competent person in accordance with the Essential Standards.

3. The NI has overall responsibility to submit reports that accurately reflect ongoing practices or occurrences, even if that conflicts with the interests of the Company or emphasises negative aspects of the Company, which includes work undertaken by the NI.

4. The NI must maintain and update relevant knowledge in relation to notifications and care provision, through the reading of relevant materials, attendance on training and refresher courses as necessary to perform the role effectively.

5. The NI must satisfy the CQC at all times that they are ‘fit for purpose’ in accordance with the Essential Standards.

6. The NI has a duty of care to report any areas of the service that they feel do not meet the Essential Standards and whereby the Company is failing to address the issues satisfactorily, without any recrimination, detriment to their role.

7. The NI is duty bound to report any change of circumstances or serious incidents under the relevant notification(s) to CQC.

Defining the role: an exemplar Job Description for a Nominated Individual

Section Section Name68 69 About the Skills Academy

About the Skills Academy

Established in 2009, the National Skills Academy for Social Care is an employer-led membership organisation focusing on leadership in the sector. It is one of the largest membership bodies in social care, with individuals and organisations amongst its members spanning providers and commissioners; residential and home care; the public, private and voluntary sectors; and all client groups. The Academy has a particular remit to work with Registered Managers, supporting them in their pivotal leadership role through a National Support Programme.

High quality leadership is fundamental to the delivery of high quality care. The 2012 White Paper, Caring for our future, emphasised the importance of leadership at all levels, from people entering the sector right the way through to strategic leaders. This view of leadership underpins the 2014 Care Act. And leadership is important for the future of social care: the sector needs to develop a pipeline of new talent, comfortable with working across traditional boundaries in integrated services and capable of inspiring the workforce of the future.

The Skills Academy therefore works to embed leadership at all levels of the social care workforce, using its Leadership Qualities Framework for Adult Social Care to instil the idea of leadership as being grounded in everyday behaviours, and therefore accessible to everyone, whatever their role. At the same time, the Academy reaches beyond the workforce to bring leadership skills and capabilities to people using services, their carers and the communities in which they live and work, so that strong leadership can support quality services and the vision we share for the sector can become a reality.

Section Section Name70 71 Acknowledgements

Acknowledgements The Skills Academy would like to thank the many individuals and organisations involved not just in this report, but also in the wider initiative of supporting Responsible Individuals in adult social care. In particular, we would like to thank Vic Citarella and his colleagues at CPEA, and Peter Kinsey, Chief Executive of Care Management Group, for working together with us on this project, and in bringing the issue to the forefront of the social care agenda. We would particularly like to thank Vic for his preparation of this Guidance. Thanks are also due to Glen Mason at the Department of Health and Alan Rosenbach at the Care Quality Commission for their commitment to supporting Responsible Individuals. We would like to thank Mat Sloan and his colleagues at Morar Consulting for compiling and carrying out the survey, and for their analysis of the results. Finally, we would like to record our appreciation of Goosebumps, who have designed Nominated as Responsible so that it is clear, engaging and easy to read. Thank you all.

Debbie Sorkin

Chief Executive, National Skills Academy for Social Care, May 2014

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National Skills Academy for Social Care

Floor 9, One Euston Square, 40 Melton Street, London, NW1 2FD

T: 020 3011 5270E: [email protected]

www.nsasocialcare.co.uk

Charity number: 1131969 Company registration: 6996828

© The National Skills Academy for Social Care 2014. All rights reserved.

In June 2014 the National Skills Academy for Social Care merged with Skills for Care.

Skills for Care Ltd, West Gate, Grace Street, Leeds LS1 2RP.

Registered company number: 3866683. Registered charity number: 1079836.

Documents

Nominated as Responsible · 2018-04-03 · Work with your organisation to define the parameters of the role ... The overall direction of travel in the social care sector is towards