Craegmoor Quality Account 2012-13

Craegmo or
Qua l it y Account 201 2 -1 3
We make things possible...
1
We make things possible...
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Contents
Part 1 – Statement from the Chief Executive
Statement from the Chief Executive
7
Quality statement from the Director of Corporate Assurance
and Chief Nursing Officer
9
Overview of the Craegmoor division
10
Positive Behaviour Support Strategy
11
The Quality team within Craegmoor
13
Part 2 – Priorities for improvement
Priorities for improvement 2013-14
14
Part 3 – Additional information
Service user satisfaction
16
Investing in staff and training
19
Regulatory compliance
20
Focus sites during 2012-13
23
Working in partnership with our commissioners and regulators
24
Improving safety for our service users
25
Continuous improvement in the delivery of our services
26
Appendix
Priory Pathways
27
Scope of data inclusion
29
3
Introduction and background
Craegmoor is part of the Priory Group of Companies, the UK’s leading provider of mental healthcare and specialist
education services.
We work in partnership with our service users and their families, as well as commissioners, regulators and other stakeholders,
to provide the best possible outcomes at every stage of an individual’s care pathway.
By providing a seamless transition for service users as they progress between higher and lower dependency services,
we ensure continuity of care that underpins the delivery of successful outcomes.
Priory Pathways*are our range of services that provide accessible expertise appropriate to each service user as part of their
personalised care pathway. This integrated approach to treatment supports the service user’s progression by providing
sustainable placements and, where appropriate, the opportunity to move back into a community setting.
This means that service users within Craegmoor can benefit from rapid access to acute and complex mental healthcare
services within Priory Healthcare, as well as specialist educational facilities within our education services. Our older service
users can also receive specialist care to meet their changing needs within our Amore Care division.
P A T H W A Y S
Acute mental healthcare
Addictions
Eating disorders
Child and adolescent mental
health services
Secure
Personality disorder
Complex care
Autism including
Asperger’s syndrome
Neuro-disabilities
Learning disabilities
Autism including
Asperger’s syndrome
Specialist further
education
Fostering
Positive Behaviour
Support
Community and
domiciliary options
(‘Supporting You’)
*For more information on Priory Pathways please see Appendix
4
m
re
Our
integrated
approach to
treatment
Ca
Hea
lt
Autism
eg
Learning disabilities
Edu
c
on
ati
are
c
h
C ra
Mental health
Behavioural, emotional and
social difficulties
oo
r
Am
e
or
Residential care
Nursing care
Dementia care
Day care
Respite care
Reablement and
convalescence care
End of life care
External review
In 2012, the Priory Group commissioned an external
review of the Group’s quality assurance and governance
processes, performed by PricewaterhouseCoopers (PwC).
The findings from the review were largely positive, and our
aim is to continue to develop market leading practices
to ensure that all Priory sites maintain their high quality
standard of service.
Seven key senior positions have since been created,
including a Director of Corporate Assurance and Chief
Nursing Officer, who has led the improvements in safety,
quality and compliance, with a Director for each of the
three functions to ensure effective delivery. Heads of
Quality for each division within the Group have also been
appointed, to take divisional responsibility for proactively
driving improvements in quality; ensuring quality
indicators, care standards and regulatory requirements
are fully satisfied.
A Quality Review Project Board was formed during the
year to ensure delivery of the planned improvements
in 2012-13. In addition, an Assurance Committee was
established, which reports to the Board on all matters
relating to safety, quality and compliance. The Assurance
Committee is chaired by a Non-Executive Director.
Our ultimate objective is to be world class and a beacon
of good practice for other health and social care providers.
In July 2013 PwC returned to undertake a further review
following implementation of the recommendations and
their key findings are detailed below:
Key achievements and improvements to date include:
b
There have been significant improvements in the
way in which the Group governs for and manages
quality, providing a better balance of focus across
financial, operational and quality performance.
b
Improvements have been made to the
measurement, monitoring and reporting of
quality across all divisions, with a shift from
predominantly compliance based indicators to a
more holistic set of quality performance indicators.
In line with good practice, reporting now consists
of a range of input, process and outcome measures
which allow for a more integrated approach to
reporting quality performance and risk.
b
b
The creation of a Head of Quality role within
each division has allowed for a much greater
degree of focus on quality and has provided
an improved level of capacity to manage
quality improvement.
b
Significant improvements have been made to
internal communications systems including the
development of a weekly newsletter sent to all
staff across the Group and a quarterly newsletter
which is sent Groupwide. In addition, regular
conference calls are now being held by the CEO
to update managers on matters from the Board’s
perspective and to recognise good performance.
The Group has made a significant investment
in enhancing its capacity and capability to manage
compliance and quality, which have delivered
a more robust, consistent and responsive approach
to managing compliance across all divisions. As a
result, the Group is more able to identify and take
prompt action to address quality performance
issues or risks, operating more proactively to drive
continuous quality improvement.
5
The Priory Group promise
Providing Quality
Quality is not only applied to the care and services we deliver, it also stretches across our staff and facilities,
ensuring optimum standards of delivery in the appropriate surroundings.
What quality means to us:
b
b
b
b
b
Consistent delivery of care and education at the highest level
Safe, effective and regulated services
Listening to our service users
The highest calibre of staff
Investing in our facilities
Inspiring Innovation
As a service provider, we are always looking for new ways to do things better. Innovation can be in the form of a new
idea or by simply being innovative with an existing one.
What innovation means to us:
b
b
b
b
Constantly reviewing the way we work to ensure we continually develop best practice
Not accepting the status quo if things could be improved
Being at the forefront of treatment and care-led trends and solutions
Creating unique and market leading practices
Delivering Value
We offer the best quality individualised programmes at competitive prices, tailored to specific treatment goals.
These programmes offer flexibility as well as the ability to reduce costs throughout treatment.
What value means to us:
b
b
b
b
6
Tailored and cost effective treatment
Remaining highly competitive in the market
Transparent and flexible pricing models
Regular pricing reviews
Part 1 – Statement from the Chief Executive
I am pleased to introduce the first annual Quality Account
for Craegmoor, which provides a summary of the
achievements of the Craegmoor division during 2012-13
and outlines our priorities for quality improvement during
2013-14.
Craegmoor is the country’s leading independent provider
of support for people with learning disabilities, autism,
complex needs, mental health problems as well as those
with behaviours that challenge.
All of us at the Priory Group are passionate about the
quality of service that we provide to all of those entrusted
into our care. Over the course of the last 12 months
we have made significant further improvements in
performance against key quality measures including
a reduction in the number of embargoes placed on our
services by the regulatory authorities.
Our focus is always on safety, effectiveness and the
experience of people using our services. Achievement of
this goal is clearly demonstrated through our service user
satisfaction survey results.
91%
have support plans
covering all needs
identified at assessment
We have a hugely dedicated, professional workforce, which
continues to deliver care to an excellent standard. The
commissioning landscape has changed significantly over
recent months and it is my aim to successfully navigate
the Group through the evolving environment, ensuring
that the wellbeing of service users and the health of our
organisation is protected and the highest quality standards
are upheld. I work closely with the Craegmoor division’s
senior management team and, to the best of my
knowledge, the information contained in this report is a
true and accurate reflection of the services and outcomes
that we have delivered.
Tom Riall
Chief Executive Officer
December 2013
94%
of people are happy with
the way they are treated
Providing innovative support across our service lines is key
to the success of the business; as such, we are working on
developing integrated care pathways that cross our
divisions to ensure we can offer a complete package of care
to service users throughout the key stages of their lives,
from inpatient care to supported living and then out into
the community. Our ultimate goal is to provide excellence
across the communities we serve.
7
Highlights from this year’s
Quality Account
What our service users think
94%
are happy with the way
they are treated
97%
feel they are treated
with respect
95%
feel safe in the home they
are living in
What our staff think
8
93%
feel they are able to contribute
to the success of their team
97%
fully understand the needs
of their service users
92%
know where to go for advice
and support when needed
Quality statement from the Director of Corporate Assurance
and Chief Nursing Officer
The Priory Group ensures that our teams are supported by
an arms length Corporate Assurance function, which has
been made possible by the significant investment in this area
that was made during 2012. This ensures that our services
are safe and effectively regulated and enhances the
effectiveness of services and care provided.
Achieving positive outcomes, coupled with the experience of
our service users and staff, defines the quality of our service
and is at the heart of everything we do. This approach is also
reflective of the national agenda for quality.
Our priorities for driving quality within the Priory Group
are to:
b
b
b
b
exceed national standards of care
improve outcomes for our service users
deliver safe and secure services
ensure a positive experience of care from all who use
our services
In addition, we will continue to invest in our staff through
education and training, which ensures that the high levels
of care that we expect are delivered.
This is reflective in the highlights from what our service
users think of us in Craegmoor and what our staff think.
Quality is at the heart
of everything we do
The Priory Group is responsive to any external investigation
that may highlight areas for improvement within health
and social care. As a responsible provider striving to make
a difference, we have signed up to the Concordant to
address poor quality and inappropriate care in response
to Transforming Care. The Group ensures that Safeguarding
is everyone’s responsibility.
In May 2013 I was appointed Chief Nursing Officer for the
Group; strengthening the voice of nursing and leading on
professional standards for all care groups. We will continue
to support our staff, hear the voice of our service users, and
safeguard our vulnerable adults in the changing health and
social care landscape to ensure we are well equipped to
meet the challenges ahead.
Siân Wicks
Director of Corporate Assurance and Chief Nursing Officer
December 2013
The way in which we aim to improve on best practice
standards is by listening to our service users. This, along
with benchmarking ourselves against National Institute for
Health and Care Excellence (NICE) quality standards and
other national and international standards, is fundamental
as we strive to make a difference to the people who use
our services.
We ensure that our policies and procedures are up to date,
evidence-based and take into consideration regional
variations from England, Scotland and Wales where
Craegmoor services are located. This not only helps us
to satisfy our regulatory bodies, but also enables us to
produce policies and procedures that are relevant and
aimed at providing the highest standard of care.
9
Overview of the Craegmoor division
Learning disability services
With the largest network of specialist learning disability facilities in the UK, we offer a flexible range of services
that include:
b
b
b
b
b
Personalised care packages, tailored to the needs of our service users
Programmes that cater for users with a dual diagnosis
Access to an education and paid employment through local colleges and other agencies
Access to a supported living environment when the individual is ready
Support from a team of specialist learning disability advisors
98%
of service users have a current assessment of their needs
98%
of service users have a named key worker
Autism services
Our specialist autism facilities provide a person centred approach to care, enabling service users to develop the
skills and confidence they require to live as independently as possible. Our services include:
b
b
b
b
Low arousal accommodation, which exceeds the latest standards
Flexible care and support packages, that are regularly assessed to reflect the progress being made
Progression through a care pathway that fulfils each individual’s maximum potential to live more independently
Support from a team of dedicated autism advisors
100% of service users have a named key worker
94%
of service users are engaged in activities in the local community
Mental health services
With a strong emphasis placed on reablement, we are confident that our service users are empowered to take
control of their own lives and have belief in their potential by providing:
b
b
b
10
Progression through a care pathway that has been tailored to suit the individual needs of the service user
Support from a dedicated specialist mental health advisor
Individual care packages that are suited the needs of the service user
98%
of support plans include personalised, outcome driven goals
90%
of service users have a named key worker
Supporting You
‘Supporting You’ is our specialist domiciliary service for people who want to live a more independent life, for
individuals who want more choice and control and who want to have a personalised service to meet their specific
needs. ‘Supporting You’ offers:
b
b
b
b
Specialist accommodation based support or outreach services into the community
Innovative, creative support which enables people with learning disabilities, autism or people who have
problems with mental health to live the lives they want and have the opportunities they aspire to
Assistance with securing and maintaining tenancy agreements alongside personal budgeting
We have ‘Supporting You’ services nationwide with flexible support packages, ranging from 24 hours per day
to several hours per week
95%
of support plans include personalised, outcome driven goals
96%
of service users have a named key worker
Positive Behaviour Support strategy
Positive Behaviour Support (PBS) is a framework approach
to working with individuals who, may at times, present with
behaviours that we find challenging (Challenging Behaviour).
PBS focuses on understanding why someone is behaving in
a certain way and therefore what function it serves for that
person. Once we have an idea about what drives a person
to behave in a certain way, we can begin to consider how
to most effectively support the person and the behaviours
we find challenging.
It uses changes in quality of life as both an intervention and
an outcome measure. Our way of working has a long term
focus, in that challenging behaviours are often of a long
term nature and successful interventions therefore need to
be maintained over prolonged periods. Our PBS approach
includes both proactive strategies for changing behaviour
and reactive strategies for managing behaviour when it
occurs, because even the most effective change strategies
may not completely eliminate risk (or challenging)
behaviours from everyone’s experiences.
Our approach is to focus on a skilled and qualified
workforce, who enable the people we support to have
highly individualised lifestyles, ensuring they are engaged
in meaningful activities and experience both community
presence and participation. Our strategy involves a
systemic and organisational approach to creating capable
environments and achieving outcomes for each individual.
PBS is values-led, in that the goal of behavioural strategies is
to achieve enhanced community presence, choice, personal
competence, respect and community participation, rather
than simply behavioural change in isolation. It is based on
an understanding of why, when and how behaviours happen
and what purposes they serve (via the use of functional
analysis). PBS focuses on altering triggers for behaviour, in
order to reduce the likelihood that the behaviour will occur.
11
12
The Quality team within Craegmoor
The name Craegmoor stands for the highest quality
in the delivery of individual services in mental health,
Positive Behaviour Support, learning disability and autism.
The division’s objective is to make Craegmoor a beacon
of good practice and leading in delivering services
by being transparent and open about its quality and
quality governance.
The Quality team is focused on ensuring a robust
approach to each area of delivery and they support
individuals, sites and the division to create a vision of
excellence. This is done through the implementation of
strategies within each of our services, alongside a clear
framework for working within both a residential and
supported living or community environment.
The Quality Development Team comprises of a number
of experienced and visionary Quality Development Leads,
who ensure that our three key service lines of mental
health, learning disability and autism, including our over
arching Positive Behaviour Support strategy, achieve
excellence and deliver practice development, training and
enabling environments that ensure individuals are at the
centre of decisions that affect their lives. Together, this
enables us to develop rich and meaningful lives with the
people who we support.
The team supports our operations function by ensuring
that quality assurance and compliance is delivered
effectively within each of our sites. To this end, we have
developed our own kite mark in achieving excellence.
Some of the tools we have developed are appropriate
for each individual area and include support planning
and record keeping. Key to all our service user groups is
ensuring that we provide enabling environments which
promote active support. Therefore, this is integral to the
training and skill development for all of our staff.
13
Part 2 – Priorities for improvement 2013-14
Quality performance indicators for the Craegmoor division
Target 1:
Target 3:
Proportion of service users with a person centred
support plan is more than 90%
The number of service users with a support plan
to manage their finances is 90% or more
•
•
Rationale: The white paper Valuing People highlights
the importance of being involved in and controlling
decisions made about your life. This is not usually doing
exactly what you want, but having information and
support to understand the different options and their
implications and consequences, so people can make
informed decisions about their own lives.
•
How will it be measured: The Craegmoor Outcomes
Project reports every six months to the Quality
Development Team and Divisional Managing Director.
•
Rationale: The publication of the White Paper Valuing
People (Department of Health (DH) 2001) set out a
strategy for the development and delivery of health and
social care services for people with learning disabilities
in England. A central component of this strategy was
to require Learning Disability Partnership Boards to
introduce person centred planning (PCP) as a means
of increasing the extent to which supports were tailored
to the needs and aspirations of people with learning
disabilities. The results of the evaluation clearly indicated
that the introduction of PCP had a positive benefit on
the life experiences of people with learning disabilities.
How will it be measured: The Craegmoor Outcomes
Project reports every six months to the Quality
Development Team and divisional Managing Director.
Target 4:
Service user satisfaction survey which states 90% or
more satisfaction with services (overall satisfaction)
•
Rationale: The Department of Health’s strategy
No Health without Mental Health (2011) sets out the
importance of ensuring that service users have a positive
experience of their care and support. This is supported by
the Mental Health Outcomes Framework (Department
of Health, 2012), which includes the importance of
ensuring a “positive experience of care”.
•
How will it be measured: Craegmoor’s service user
satisfaction survey is conducted annually and results
are reported to the senior management team
to allow action plans to be developed around service
user feedback.
Target 2:
Proportion of service users with a Health Action Plan
is 90% or more
•
•
14
Rationale: The white paper Valuing People (Department
of Health (DH) 2001a) stated that each person with a
learning disability would be offered a health facilitator
by 2003. The role of the health facilitator is to support
people with learning disabilities in getting the health
care they need. It also stated that this client group
should be registered with GPs who must identify all
people with a learning disability who are registered with
their practice and also that they should have a health
action plan – a communication tool used by clients to
highlight needs and choices – by 2005.
How will it be measured: The Craegmoor Outcomes
Project reports every six months to the Quality
Development Team and divisional Managing Director.
Quality performance indicators by service line
90% or more staff in sites offering mental health
services will have completed an e-learning module
on Recovery in Mental Health
90% or more staff in sites offering autistic spectrum
condition services will have completed an e-learning
module on autism
•
•
Rationale: No Health without Mental Health
states that front line workers should be trained
to understand mental health and the principles
of recovery
Rationale: The Autism Act 2009 led to the production of
Fulfilling and rewarding lives: a national autism strategy –
published in March 2010. The strategy states the need
for improving the training of frontline professionals.
90% or more staff in sites offering Positive Behaviour
Support will have completed an e-learning module on
managing challenging behaviour
90% or more staff in sites offering learning disabilities
services will achieve an e-learning module on learning
disability
•
•
Rationale: Challenging behaviour: a unified approach
(Royal College of Psychiatrists, 2007) set out a
framework for training health and social care
professionals, paid support staff and carers in
behaviour management.
Rationale: The Autism Act 2009 led to the production of
Fulfilling and rewarding lives: a national autism strategy –
published in March 2010 and dealing with elements of
learning disability as well as autism. The strategy states the
need for improving the training of frontline professionals.
15
Part 3 – Additional information
Service user satisfaction – delivering value through positive outcomes
Service user satisfaction is key in enabling us to develop our services around the people who use them. Craegmoor prides
itself in putting our users first and by understanding people better, we can offer tailored care and support packages and
improve what we do. No one can guide and influence us better than the people who live in or use our services.
The following results have been taken from our service user satisfaction survey April 2012 to March 2013.
Overall satisfaction with the support our service users receive from staff
92%
Mental health services
94%
95%
Learning disability services
92% Supporting You*
Autism services
What our service users thought of the services we provide
Mental health
services
Autism
services
Learning disability
services
Supporting
You*
Staff treat me
with respect
96%
98%
97%
94%
I am happy with the
way staff help me
87%
95%
96%
93%
I am helped to be
as independent
as possible
92%
97%
96%
93%
I feel safe at the home
91%
98%
95%
91%
I can have a say in
how my care and
support is provided
89%
94%
96%
89%
*Supporting You is Craegmoor’s domiciliary care agency, which is registered with all national bodies and provides supported living frameworks across the UK.
16
Relatives/advocates of our service user satisfaction
It is important that we keep not only our service users happy, but also the family members or advocates who mean most
to them. This is why we have extended our satisfaction surveys to include this group of people.
100
90
80
70
60
50
40
30
20
10
0
I am happy with
the way staff
treat my relative
The home is nice
and clean
The staff treat my
relative with respect
Staff give him/her
enough time and
don’t rush them
They get the right
amount of help and
support from staff
Comments from relatives
Routine, structure and consistency from a team of truly dedicated
hard working staff. All the carers are happy, energetic and enthusiastic.
A fabulous service!
Laura* is quite obviously happy
where she lives. This is evident
whenever I see her, or return her to
‘The Old Rectory’. She appears to live
a full and active life. Thank you!
The service is very good!
They are all 100% caring and
look after my daughter very
well and help her with all her
day to day care!
*Name has been changed to protect identity
17
your
voice
Ask.Voice
Listen. Do
Your
Craegmoor is committed to supporting the people we care
for in a person centred way. The use of ‘Your Voice’ in
gaining views of the people we support is effective and we
have developed new approaches to ensure everyone’s voice
is heard and is key to user involvement. Members of the
Quality Development Team will lead and work alongside
people who use our services to ensure that they have an
active voice in their home, regionally and with the Board
nationally. This will include an elected members council
who will be elected from services to meet regionally and
elected members who will meet nationally. There will be
an advisory council developed that will also be elected for
advice and guidance for the service lines of Craegmoor.
Both groups will meet to voice improvements to the
senior management team of Craegmoor twice a year.
House/Service
Meeting (monthly)
Service Level
Regional Meeting
(quarterly)
Regional Level
Senior Manager Meeting
(every 6 months)
Divisional Level
18
We will engage with the people we support to identify
ways to consult in a meaningful way, developing a range
of resources to aid the process, training staff in the agreed
system, developing a structure involving senior managers
and policy writers so that the people we support have
their views heard and acted upon.
Developing advocacy is the key to enabling and
empowering our service users. Over the last 20 years
advocacy systems and processes have been developing,
as a result some people we support have already
developed good self advocacy skills and are able to speak
up for themselves well. Others are accessing community
groups to develop their peer and citizen advocacy roles.
The further development of the ‘Your Voice’ process will
initially support the development of advocacy skills along
with a business wide approach to gaining views from the
people we support.
Investing in staff and training
Learning and development
We recognise the important contribution that staff make both in terms of the quality of care delivered and service user
experience. Foundations for Growth, our internal e-learning programme for staff, was launched seven years ago and in
2012-13 alone, the programme has enabled Craegmoor staff to complete 87,839 e-learning modules and 6,863 face
to face training sessions.
Percentage of allocated e-learning modules completed by Craegmoor staff during 2012-13
Confidentiality and Data Protection
98%
Introduction to Asperger’s Syndrome
97%
Managing Challenging Behaviour
93%
Crisis Management
98%
Introduction to Autism Spectrum Disorder
97%
Safe Handling of Medicines
100%
Deprivation of Liberty Safeguards
95%
Introduction to Learning Disabilities
97%
Safeguarding Vulnerable Adults
96%
While managing Glebe House,
we achieved consistent CQC and
Internal Inspection Compliance
and developed a wealth of
positive working relationships
with key commissioners and
partner agencies. Given the
opportunity of managing multiple
sites and service development,
I was successfully appointed as
an operations support manager,
providing advice and support
to service managers across
the division
19
Regulatory compliance
Craegmoor covers England, Scotland and Wales and is therefore required to work under the standards set out by regulators
within each respective area. 132 sites were inspected by regulators between 1st April 2012 and 31st March 2013. These are
broken down by regulator as follows:
Care Quality Commission 122
Care Inspectorate Scotland 6
Care and Social Services Inspectorate Wales 4
Care Quality Commission
The Care Quality Commission inspected 645 outcomes
identified in the Essential Standards of Quality and Safety
across Craegmoor’s English sites between April 2012 and
March 2013.
Of the 645 outcomes assessed, 71 were found to be
unmet within 17 areas of inspection.
89%
of outcomes were judged
to have been met
(CQC benchmark is set at 80%)
Compliant
Not compliant
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Cleanliness
and
infection control
20
Respecting and
involving people
who use services
Safeguarding
people who use
services from abuse
Requirements
relating to
workers
Supporting
workers
Safety and
suitability of
premises
Care Inspectorate Scotland
Care and Social Services Inspectorate Wales
The Care Inspectorate Scotland inspected 21 requirements
identified in the regulations at Craegmoor’s six Scottish sites
between April 2012 and March 2013. The Inspectorate
found five sites that were compliant in all requirements.
The Inspectorate found one site with four unmet outcomes
and in partnership with the Local Authorities individuals
were moved to new homes.
The Care and Social Services Inspectorate Wales inspected
16 standards across Craegmoor’s Welsh sites between
April 2012 and March 2013. The Inspectorate found that
all standards were judged to have been met in all sites
in Wales.
Requirements inspected
Met
Unmet
Standards inspected
Met
Unmet
Care and support
5
1
Quality of life
4
0
Environment
3
1
Staffing
4
0
Staffing
4
1
Management /Leadership
4
0
Management /Leadership
5
1
Environment
4
0
81%
of requirements inspected
by CIS were met
100%
of standards were judged
to have been met
21
Case study
David
David*, who lives in the supported living environment
at Levitt Mill and Barn, passed his Diploma Level One
in Construction in 2012. David’s achievement has
spurred him on to register for a further qualification,
Level 2 Diploma in Joinery. Throughout his course David
has also been gaining practical experience with Levitt
Mill and Barn’s maintenance assistant, Richard Todd.
The Craegmoor team at Levitt Mill and Barn are all very
proud of David and his achievements at college which
have seen him flourish throughout his course. David has
a fantastic support network around him and Levitt Mill
and Barn encourages all residents to live as independently
as possible.
David, Craegmoor’s Levitt Mill and Barn, Rotherham
After several set-backs in his life, David, who has ADHD
and IED (Impulsive Explosive Disorder) has progressed in
his care pathway to be able to attend college full-time.
His course structure included one-to-one sessions to
ensure support was provided to help David to achieve
his diploma. The Craegmoor ethos encouraged and
supported David to get involved in leisure activities,
and where possible, educational ventures in the
local community.
David said “I am really proud of what I have
achieved so far. I really enjoy going to college and
I haven’t missed a day of training since I started
the course.”
Attending routine
lessons and working in
a hands-on environment
has helped me to
channel some of my
aggression and
emotions
*Name has been changed to protect identity
22
Focus sites during 2012-13
From time to time, particular areas of care or service delivery fail to achieve the high standards of quality that our regulators
and service users rightly expect. This section details areas in which compliance with our regulatory bodies fell short and
required remedial action to be taken.
On the rare occasion that an issue should arise, we communicate openly and always work as closely as possible with our
regulators and commissioners, service users, their families and carers and other external stakeholders for as long as necessary
to ensure full confidence in our service is restored.
Positive Living London and Thames Valley
Quality issues were identified in one of our supported
tenancies within this service. In December 2012,
the CQC issued a warning notice and an action plan
was implemented to address these issues. Following
re-inspections from the CQC and a responsive intervention
plan, the service was found to be compliant with the
regulations within 4 weeks of receiving the warning
notice. The internal compliance team and the operational
management of the service continue to implement and
monitor improvements to ensure future and ongoing
compliance.
A new management team and Quality Team ensured that
individuals who lived at the home received the very best
support and care. Craegmoor made the decision to place
a very short voluntary suspension with the commissioners.
The home achieved a rigorous action plan and the CQC
inspected the home in November 2012 and stated it was
compliant with all outcomes. The home has gone on to be
a centre of excellence for people whose behaviour may
challenge themselves or others.
The Shores – Poole
Following an Inspection by CQC in November 2012, a
concern regarding medication was found. A warning notice
was given by the regulator. In consultation with the Local
Authority and pharmacy services, a robust action plan was
created. Service users remained safe through this process
and the systems for medication were enhanced. The CQC
inspected the home in early January 2013 and found the
site to be compliant with all outcomes inspected. On
completion of the investigation and implementation of
actions arising, commissioners were satisfied that the
support we deliver to individuals had improved and an
agreement on monitoring in partnership was implemented.
Melling Acres
Following a previous CQC inspection and a review of the
actions taken by the site in July 2012, the regulator felt that
further work was needed to meet the inspection outcomes.
As a result, a warning notice was issued to the site. During
this time, Craegmoor worked closely with commissioners,
service users and their families to ensure we communicated
our robust action plan in response to the notice.
23
Working in partnership with our commissioners and regulators
Delivering quality care and services in the changing health and social care systems in the UK requires a greater focus on the
outcomes achieved for people who use our services. To achieve this:
b
b
b
We constantly strive to deliver the most effective outcomes through innovative approaches to delivering care, support
and treatment
We support and enable people to maximise their potential for independence and achieve fulfilling lifestyles, including
exploring opportunities for employment and voluntary, meaningful activities, working within all key national guidance
regarding choice, control and self determination
We ensure that our multidisciplinary and community based teams work in collaboration with the people we support
and their family, social workers and where applicable their GP, to ensure that placements are as beneficial and timely
as possible
Together, this approach ensures that everyone we support receives a consistently high standard of care and enablement,
no matter when or where they are admitted or live. This approach is reflected in our excellent outcomes and comprehensive
specialist and community based support.
We have worked closely with the service in recent
months and have found that all staff we have dealt with
are very professional, committed and eager to continue
developing a working relationship
Sandwell Council, West Midlands
24
Improving safety for our service users
As a Group, Priory strives to foster an open and transparent culture, in which staff feel able to report incidents as they occur.
We believe that this approach is fundamental to driving improved processes and practices within our services.
Craegmoor reports all incidents using a bespoke electronic reporting system, to which all clinical staff are provided access.
Its use is explained during the staff member’s induction and an overview of the importance of incident reporting is also
included within the e-learning modules on Safety, Quality and Compliance.
In line with the ethos of the National Patient Safety Agency, we encourage our staff to report all incidents, serious incidents
and near misses using this reporting system.
2011-12
2012-13
6.9
9.4
Serious incidents relating to the death of a service user
0.5%
0.3%
Incidents resulting in the permanent harm of a service user
0.9%
0.3%
Total number of incidents reported (per 1000 occupied bed days)
Incident: An unplanned, undesired event that hinders completion of a task and may cause injury, illness, or property damage
or some combination of all three in varying degrees from minor to catastrophic. All incidents are reported whether the
event is expected (where a service user’s health is known to be deteriorating) or unexpected.
Peter
Peter, 45, owns his own house, is in paid employment, manages
his personal budget and leads a full and active social life. After
many years living in services this is a life-changing scenario
for Peter and one he is embracing fully and confidently.
Peter moved into Craegmoor’s Glebe House in Market Rasen
around six years ago.
With support from Craegmoor’s ‘Supporting You in
Lincolnshire’, Peter began the next stage of his life. His support
worker is a former deputy manager at Glebe House and her
relationship with, and knowledge of Peter and his triggers,
went a long way towards breaking down the barriers towards
independent living.
It was two years before Peter became fully engaged in the
programme at Glebe House. He involved himself in courses
to teach life skills and undertook an NVQ in woodwork.
The confidence this gave him, lead him to consider buying
his own home using money he had inherited.
He has taken ownership of his personal budget, been
discharged from his social worker and been taken off the
Care Programme Approach. Peter is still a frequent visitor
at Glebe House and enjoys seeing the staff who contributed
to his success. Through the Pelican Trust, Peter is putting his
woodworking skills to good use earning money making a
variety of products including test tube holders, wooden plaque
stands and bird tables. In his own words Peter says:
Peter was determined to find the right property, somewhere
he felt comfortable and was close to Glebe House, his support
network and friends. He is well-known and liked in the local
area and wanted to remain a part of the community which
had contributed so much to his pathway to independent living.
Supported by his carers at Glebe House, Peter embarked on his
own ‘Location, Location, Location’ property hunt. After around
30 viewings, eventually the perfect house was found and
despite a few difficulties an offer was made, accepted and
Peter moved in.
“I have been in services for years but now I have got
myself a house. It was a lovely thing to feel like I am on
my way outside of the home. I now feel like I am starting
afresh with a new life. I feel like all my stresses have gone”
Peter, Craegmoor’s Glebe House, Market Rasen
25
Continuous improvement in the delivery of our services
Providing a high quality service for both our service users and those who commission our services is a central objective for
the Craegmoor division. As such, we take all complaints very seriously and utilise this feedback as part of an overall ethos
to drive service development through continuous improvement. Over the course of 2012-13, we have implemented a more
thorough and effective reporting mechanism in order to ensure that the management and resolution of complaints is
handled with greater efficiency and transparency.
We operate a robust and thorough framework for managing all complaints, which comprises of three stages:
Complaints during 2012-13
Stage one
Complaints are resolved at a local
level by the individual service or
site within an agreed response
timeframe. Whilst the majority
of complaints are satisfactorily
resolved in this manner,
a complainant may request in
writing that the issue be referred
to stage two if they remain
dissatisfied, following a final
attempt to resolve by further
dialogue or meetings
Stage two
The complaint is reviewed and/or
reinvestigated by the Group
Complaints Co-ordinator (part
of the Safety, Quality and
Compliance team) within an
agreed response timeframe
Stage three
Further and final recourse for
unresolved complaints is available
through the local government
Ombudsman
26
Following the implementation of a more robust reported system in 2012,
Craegmoor has seen the number in complaints at stage two increase from
zero during 2011-12 to two during 2012-2013.
Zero cases have been referred to stage three (local government ombudsman)
during either 2011-12 or 2012-13.
Complaints per 1000 occupied bed days
2011-12
0.29
2012-13
0.30
Appendix
Priory Pathways
The Priory Group of Companies, including Craegmoor, work closely with community healthcare professionals and
commissioners to provide a stable and safe environment for the service user as part of a seamlessly integrated care pathway,
outlined below. This ensures accessible psychological expertise, continuity of care and the delivery of positive and
measurable outcomes. The individual may enter and leave the pathway at any point depending on their individual needs.
Independent
hospitals
Residential
services
Craegmoor
“Supporting You”
Priory Education Services
Our services aim to enable every person to leave education with externally recognised qualifications and provide them with
opportunities to achieve their potential and personal success. We offer individually tailored education plans for young people
with autism and Asperger’s syndrome, learning difficulties and behavioural, emotional and social difficulties, which are
provided in highly structured and predictable environments. These are tailored to the unique needs, sensory profiles and
learning abilities of each young person. Successful placements are achieved through flexible packages of education, therapy
and care, designed to support each individual.
Priory Acute Services
Our hospitals carry out a comprehensive needs assessment, risk formation, in depth diagnostics and recommend the most
appropriate treatment. A wide range of psychological therapies are offered to help develop and optimise coping strategies
and social skills in a structured environment.
27
Craegmoor Residential Services
Craegmoor provide a range of specialist services including support for people with learning disabilities, autism, mental health
issues and behaviours that challenge. We can provide continued support for those who require residential care, with the view
of stepping down to a more independent environment, where possible. We provide a seamless pathway from our hospitals
within the Priory Group while maximising the potential to make a transition to more independent living.
Craegmoor “Supporting You” Services
The services are supported by our team of specialist autism advisors, who aim to empower service users to take control
of their lives and progress through our care pathway within the Priory Group of Companies, developing their levels of
independence, and where appropriate, transfer seamlessly to a supported living model delivered by our domiciliary care
agency, “Supporting You”, which is registered with CQC, The Care Inspectorate and CSSIW. This model operates across England,
Scotland and Wales and is key to further developing the levels of independence of our service users in their own home.
28
Scope of data inclusion
The 2012-13 Quality Account provides an overview of the performance of Craegmoor against a wide range of internal
measures and metrics. In some cases, data does not represent the entire breadth of services or sites within Craegmoor.
This appendix sets out the scope of data inclusion, as well as any relevant considerations, such as methods by which samples
were selected for analysis.
The section below shows which sites belong to each service line within Craegmoor. Sites marked with an * are also Positive
Behaviour Support sites.
Mental health services
b
b
b
b
b
b
b
Anchor & Haven House
Bromyard Road*
Bridgeway
Charnwood Lodge
Church View
Devon House*
Fitzwilliam Lodge*
b
b
b
b
b
b
Glebe House
Linden Lodge*
Oaklands Derby
The Birches*
Westfield House*
Woodthorpe Lodge*
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
Millburn Homes*
Old Rectory Trowbridge
Orchard House*
Piers
Red House*
Ridgecott*
Riverview
Rose Farm House*
Roseneath Avenue
Seabreezes*
Shieling
St Brannocks
St Michaels*
St Winnow
Swerford
Tithe Barn
Turketel Road*
Udal Garth*
Waves
Weir End & Woodpecker
Wells Road
White House*
Wolverton Court
Woodhouse Cottage*
Woodhouse Hall*
Autism services
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
55 Sandwich Road
Bank Hall Farm*
Carlton House*
Cherries*
Cherrywood WSM
Collinson Court*
Conquest House*
Coolhaze
Corals
Cotswold Lodge*
Dunes
Eastleigh House*
Ebbsfleet*
Evergreen*
Fair View Lodge
Finn Farm Lodge*
Hamilton House
Julians Road - Not operational at present*
Kinsley Autism Services*
Lammas Lodge
Levitt Mill & Barn
Lodge*
Maple House
Martins*
Melling Acres*
Mews Bramley*
29
Learning disability services
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
49 Dinorwic Road & 53 Arbour Street
Aire House
Alexandra House
Alphonsus
Anchor House*
Ardsley House
Ashridge*
Bay*
Beach House*
Belmont Road*
Birches
Blair House
Blyton Court
Brickbridge House
Brooke House
Bryngwyn Road
Cedars Gloucester
Combs Court*
Conquest Lodge
Daisy Vale
Devonshire Road
Dolphin Lane
Drummond House
Dunvegan
Ebbsfleet*
Eden Cottage
Elm Tree
Foam*
Gateholme
Gatehouse Cottages
Georgina House
Halifax Drive
Heighton House*
High Cross House*
Hobbits Holt*
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
b
Homeleigh Farm
Kalmia & Mallow*
Kirklea
Laburnum House
Lansdowne Road 67-71
Lawrence*
Mar Lodge
Marshlands
Mayfield House
Millcroft
Moorings*
Newhouse Kilmarnock
Oaks & Woodcroft
Ogilvie Court*
Old Rectory Brede
Old Vicarage Bristol
Preston Avenue*
Progress House
Ravenlea*
Redlands
Robinson House*
Rose Cottage
Rose Court
Seabourne House
Shores*
Station Road*
Strathmore House*
Tides*
Vaughan House*
Westbury Lodge*
Westview
Wheelhouse
Willows Hythe*
Windsor
b
b
b
b
b
b
b
b
b
b
SYI Lincolnshire
SYI Luton*
SYI North East England
SYI North London
SYI Somerset & Devon (ABI Service)*
SYI South
SYI South East*
SYI South Wales (Physical Disability Service)*
SYI South West*
SYI West Midlands*
Supporting You
b
b
b
b
b
b
b
b
b
b
30
Bentons Lane
Blurton Road
Enfield 1
Enfield 2
HQL Dom Care*
PL London*
SYI East Anglia
SYI East Midlands*
SYI Glasgow
SYI Herefordshire*
Service User Satisfaction Survey –
pages 8 and 16
Craegmoor carried out their annual service user satisfaction
survey in April 2013. Surveys were offered to all service
users resident in the participating sites during the period
April 2nd to May 3rd 2013.
Data was collected from a sample of sites across all four
service lines, with 58% of Craegmoor sites participating
in the survey.
‘Agreement’ or ‘Satisfaction’ is defined as those people
scoring 3 or 4 on a 4 point scale. Missing responses or
people answering ‘Don’t know’ are excluded from the
percentages presented.
Staff satisfaction survey – page 8
All Craegmoor sites included across all service lines.
Quality performance indicators – page 11
All Craegmoor sites included, across all service lines. Data
was obtained from a one-off snapshot of data regarding
service users resident within Craegmoor sites during August
2012. Figures presented show the proportion of service
users meeting the indicated outcome, not counting service
users for whom the outcome was not applicable in the
numerator or denominator.
Learning and development – page 19
All Craegmoor sites included across all service lines.
Regulatory compliance – pages 20 and 21
Incidents – page 25
All Craegmoor sites are included, across all service lines.
Incidents which meet both of the following criteria
are included:
1. The incident involves at least one service user as a
participant (incidents involving more than one service
user are counted as one incident)
2. The incident is reported on the Priory Group clinical
governance system
The Priory Group implemented a new incident and
complaint reporting system on 1st January 2012, including
a revised incident management and reporting policy.
Craegmoor sites became fully integrated with the
introduction of that system. As such, data for the 2011-12
financial year includes only those incidents and bed days
in the final quarter of the year (January to March 2012).
The number of bed days used in the denominator of the
incident rate calculation also only includes bed days in that
period to ensure a fair like-for-like comparison between the
two financial years.
Incidents leading to permanent harm are defined as those
having a “high” overall level of harm (second highest on
a five point scale) and are defined as “Any incident that
appears to have resulted in permanent harm to one or
more person. Serious injury resulting in brain damage, loss
of limb or impaired use”. Incidents leading to the death of
a service user are defined as those having a “death” overall
level of harm (highest rating on a five point scale). These
are defined as “Any incident that directly resulted in the
death of a service user”. Both of these types of incidents
have been manually checked to eliminate any obvious errors.
All Craegmoor sites included across all service lines.
Complaints – page 26
As in ‘Incidents’ above, complaints data for Craegmoor prior
to January 2012 was not available for analysis. As such, data
for the 2011-12 financial year includes only the fourth
quarter of that year. The number of occupied bed days
used in the denominator of the complaint rate calculation
also includes only those bed days in the fourth quarter of
2011-12, ensuring that a like-for-like comparison can be
made. All Craegmoor sites are included across all service lines.
31
About our Group
The integrated strength of each service provides a
seamless transition for the individual as they progress
between higher and lower dependency care and
across services. This unique approach ensures that
every individual has the opportunity to achieve the
best possible outcomes and quality of life with
the Priory Group.
As 85% of our services are publicly funded and
delivered in partnership with commissioners, our
teams work with commissioning bodies across the
country to provide transparent pricing models and
evidence-based care programmes.
Craegmoor, Part of Priory Group, 80 Hammersmith Road, London, W14 8UD
100
PG04581/Dec13
Craegmoor is part of the Priory Group of Companies.
From education to hospitals, care homes and secure
facilities, the Priory Group of Companies offers
individually tailored, multidisciplinary treatment
programmes for those with complex educational
needs or requiring acute, long-term and respite
mental healthcare.