The New KLOEs: A Brief Introduction...Introduction to the KLOEs –V81K “There are five questions we ask of all care services. They're at the heart of the way we regulate and they

Introduction to the KLOEs – V81K 1

The New KLOEs: A Brief Introduction

Introduction to the KLOEs – V81K

CONTENTS

The New KLOEs: A Brief Introduction

Page 3 What are the KLOEs?Page 6 What’s changed and why?Page 8 What do I have to do?Page 10 What are the key changes?

o Safeo Effectiveo Caringo Responsiveo Well-led

Page 16 Further resourcesPage 17 Contact the teaml Portal User Guide


What are

the KLOEs?


WHAT ARE THE KLOES?

KLOE is a commonly used acronym for the Care Quality

Commission’s (CQC) ‘Key Lines of Enquiry.’

The KLOEs are the subsets of the ‘five key questions’ that the

CQC asks of every health and social care organisation that

they inspect. These key questions are:

Is it safe?

Is it effective?

Is it caring?

Is it responsive to people’s needs?

Is it well-led?

They were officially launched in November 2017 and all

organisations within the health and social care sector need to

ensure that they are aware of them.

The KLOEs can vary depending on the specific sub-sector of

care being inspected, but some are mandatory across all.


“There are five questions we ask of all care services.

They're at the heart of the way we regulate and they

help us to make sure we focus on the things that matter

to people.”

CQC, The five key questions we ask, www.cqc.org.uk


What’s

changed

and why?


WHAT’S CHANGED

AND WHY?

Changes were proposed by the CQC as part of their ‘Next

Phase’ of consultation held between December 2016 and

February 2017.

They explained that:

The changes have simplified the KLOEs and prevent

duplication across different service types

The KLOEs are therefore becoming more standardised

across different types of services

The KLOEs for residential care and community care have

been merged

The wording of the KLOEs has also been changed:

It now aligns more closely with the assessment frameworks

for healthcare and adult social care

The language used has also been simplified in response to

the outcome of the public consultation


What do I

have to do?


WHAT SHOULD I DO?

Care providers should:

Familiarise themselves with the new KLOEs

Read the guidance provided by the CQC – it highlights

changes to the old framework and the new prompts and

key lines of enquiry

Check whether they are compliant

Care providers should not:

Worry! A setting that is already compliant should not be

phased by the new KLOEs, but must be familiar with them

What if a provider is not compliant?

They should begin forming an action plan to become

compliant

The CQC provides a guidance document online.


What are the

key changes?


KEY CHANGES: SAFE

S1: How do systems, processes and practices safeguard people

from abuse?

The CQC have changed this area considerably to align it more

closely with the healthcare framework

The language now emphasises systems and processes rather

than just “how”

There is also a new prompt asking whether those accused of

poor safeguarding practice understand their right to have

access to an advocate

S2: How are risks to people assessed and their safety monitored

and managed so they are supported to stay safe and their

freedom is respected?

The key change here is a requirement that records are

“accurate, complete, legible, up-to-date, securely stored and

available to relevant staff ”

Again, this is mainly to align the adult social care framework

with that of health

The prompt regarding managing behaviours that challenge has

also moved to this section from ‘Effective’ – although this

does not reflect the new emphasis on Positive Behaviour

Support from Skills for Care


KEY CHANGES: SAFE

S3: How does the service make sure that there are sufficient

numbers of suitable staff to support people to stay safe and

meet their needs?

The spirit of S3 remains largely the same, but the language

is much more simple and specific, discussing rotas and

people’s competencies and skills

There is an important KLOE here around staff training on

safety systems and other internal processes

S4: How does the provider ensure the proper and safe use of

medicines?

An ambiguous prompt around the service user’s taking of

“unlicensed” medicines has been removed

There are two new prompts that reflect the closer

integration between health and social care, with one asking

how the organisation interacts with healthcare

professionals around the prescription and administration of

medicines, and passing on information around medicines

between different care settings


KEY CHANGES: SAFE

S5: How well are people protected by the prevention and

control of infection?

There are two new substantial prompts

The first asks how settings respond to infection issues

The second demands that all staff have received appropriate

food hygiene training and that effective procedures are in

place

S6: Are lessons learned and improvements made when things

go wrong?

S6 is the brand new adult social care framework, and

emphasises the importance of reflecting on everyday

operations and issues

The main focus is on safeguarding and safety

It will be important for care settings to read this section and

understand the CQC’s expectations


KEY CHANGES:

EFFECTIVE

E1: Are people’s needs and choices assessed and care,

treatment and support delivered in line with current

legislation, standards and evidence-based guidance to

achieve effective outcomes?

Wording has changed from talking about “effective care”

and “best practice” in the previous framework to talking

about “needs and choices” (person centred)

There is also a wording change to promote the importance

of the Equality Act and preventing discrimination when

delivering care

E1 also features a prompt that effectively encourages

settings to embrace technology to deliver care and

promote independence

E2: How does the service make sure that staff have the skills,

knowledge and experience to deliver effective care and

support?

Ensure you have training records and development plans

for all staff. Phrases such as “professional practice” reflect

the emerging movement in the sector to raise the profile of

care workers, which can also be seen in the development

of Skills for Care’s ‘career pathway’

Think about how you can professionalise your practices in

the area of learning and development

Encourage self-development, and ask your staff to think

about how they see their careers growing within the sector


KEY CHANGES:

EFFECTIVE

E3: How are people supported to eat and drink enough to

maintain a balanced diet?

There is not a great deal of change to this KLOE, except the

simplification of some of the language

E4: How well do staff, teams and services within and across

organisations work together to deliver effective care,

support and treatment?

This is a section moved from ‘Responsive’, so you should

already be compliant

BUT - think about how you can embrace the closer

integration of healthcare and social care, and how you

work with other organisations

E5: How are people supported to live healthier lives, have

access to healthcare services and receive ongoing healthcare

support?

Again, there is little change here except around language

E6: How are people's individual needs met by the adaptation,

design and decoration of premises?

There is a note attached to this KLOE, stating that it is relevant

only to those who provide nursing or personal care, which as

we know is an increasing proportion of social care services.

This is a very person-centred KLOE, and even if you do not

currently provide nursing or personal care, you should be

thinking broadly about how you put the people you support at

the heart of everything you do

E7: Is consent to care and treatment always sought in line with

legislation and guidance?

Formerly E2, the biggest change here is the addition of a

prompt around the monitoring of the process of seeking

consent

The main focus here is on mental capacity and safeguarding


KEY CHANGES: CARING

C1: How does the service ensure that people are treated with

kindness, respect and compassion, and that they are given

emotional support when needed?

Wording change to align with the health framework

A new prompt to ensure the way you communicate with

people being is suitable for their requirements under the

Equality Act

Another new prompt requires staff to be “compassionate,

respectful and empathetic”. This is a result of consultation

feedback, but may also be a response to scandals where

people have not been treated with compassion, respect or

empathy

Complying with this KLOE will rely on effective recruitment,

training and organisational culture


KEY CHANGES: CARING

C2: How does the service support people to express their

views and be actively involved in making decisions about

their care, support and treatment as far as possible?

A new prompt (C2.1) assessing whether staff recognise

when a person needs help or support. This is about staff

members’ judgement as to when they should promote

independence and when they should intervene. Training

and feedback from supervisors is key here

C2.3 is about managing time more effectively and

reflecting. This prompt comes from the consultation, but

may also be in response to the staffing cuts occurring

across the sector. It is a requirement that care homes have

suitable staffing levels to ensure everyone is receiving

enough attention to make them feel valued

C3: How are people's privacy, dignity and independence

respected and promoted?

Noticeable change in C3.8, which requires all settings to

consider how they provide young adults in their care with

privacy and choice. There is an underlying move within

social care to break the view that it is all about the elderly

C4, which focused on end of life care, has been moved to

‘Responsive’


KEY CHANGES:

RESPONSIVE

R1: How do people receive personalised care that is

responsive to their needs?

Once again, the big change here is a requirement for

settings to embrace technology as a way of personalising

care, but also to ensure they are working properly

R2: How are people’s concerns and complaints listened and

responded to and used to improve the quality of care?

This section of the framework has been strengthened with

R2.4, which is about protecting those who raise concerns

or complaints from discrimination and retaliation

Make sure you have processes in place that allow any

complaints to be recorded and handled by someone as

independent as possible

R3: How are people supported at the end of their life to have

a comfortable, dignified and pain-free death?

There is a lot of change to this KLOE, with three new

prompts

R3.4 acknowledges how people’s conditions can change

quickly and dramatically in the final stage

R3.5 places an even greater emphasis on the family

R3.6 broaches the subject of the aftercare of the body


KEY CHANGES:

WELL-LED

W1: Is there a clear vision and credible strategy to deliver high-

quality care and support, and promote a positive culture that is

person-centred, open, inclusive and empowering, which

achieves good outcomes for people?

There are a lot of changes around building the right

organisational culture, with the phrase “open culture”

There are additional prompts on equality and inclusion, and

building a collaborative culture

Engendering the right company culture requires a

combination of good recruitment based on behavioural

competencies, training and supervision

W2: Does the governance framework ensure that

responsibilities are clear and that quality performance, risks

and regulatory requirements are understood and managed?

A governance framework specifies people’s roles and the

division of responsibility

A new prompt on information governance, a topical issue that

with the new General Data Protection Regulations (GDPR).

Ensure you are well informed on data protection issues and

have good processes, as the punishments can be severe


KEY CHANGES:

WELL-LED

W3: How are the people who use the service, the public and

staff engaged and involved?

This new KLOE aligns closely with W1, in that it is aiming to

achieve a more open and collaborative culture

Establishing how staff become more engaged in the service

they provide can be difficult, but can also be as simple as

just asking for their opinion whenever there are substantial

changes

W4: How does the service continuously learn, improve,

innovate and ensure sustainability?

Technology appears again in the new prompt W4.6, this

time questioning how the care setting uses technology to

measure and monitor care

W5: How does the service work in partnership with other

agencies?

Again, there is evidence of the trend to promote integration,

with W5.4 prompting the effective sharing of information

between agencies and services


Further

resources


FURTHER RESOURCES

There are a wealth of resources available online to provide more information guidance

and advice about the KLOEs.

Some of these resources include:

CQC - Key lines of enquiry, prompts and ratings

characteristics for adult social care services

https://www.cqc.org.uk/sites/default/files/2017

1020-adult-social-care-kloes-prompts-and-

characteristics-showing-changes-final.pdf

CQC - Key lines of enquiry, prompts and ratings

characteristics for healthcare services

https://www.cqc.org.uk/sites/default/files/2018

0628%20Healthcare%20services%20KLOEs%20p

rompts%20and%20characteristics%20showing%

20changes%20FINAL.pdf

CQC – Adult social care: information for

providers

https://www.cqc.org.uk/guidance-

providers/adult-social-care


CONTACT THE

TEAM

FRT Client Services

[email protected]

Amy Ridge, Client Services Director

[email protected]

Ryan Davis, Relationship Director

[email protected]

Call us:

0800 310 2300Visit www.firstresponsetraining.com


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The New KLOEs: A Brief Introduction...Introduction to the KLOEs –V81K “There are five questions we ask of all care services. They're at the heart of the way we regulate and they