I often compare my experiences in older people’s services compared to my days in learning disability homes. Despite the two falling under the same regulations, there is a significant difference in working age adults compared to older people – especially in terms of goal setting.
In this blog post, I discuss the importance of goals for the people we support, why the Care Quality Commission (CQC) look for evidence of it, and how you can get your service users involved in setting their own goals.
Why are goals important for the people we support?
Setting goals for service users is no different than the goals we set for ourselves. They help to provide direction and purpose.
Goals are a powerful motivator and give people, regardless of age, something to strive for. They help maintain focus and drive, and links to improved well-being and happiness.
Person-centred care plans should include the individual's goals. They should also include details of how care staff can support to achieve them.
We often think of goals as being elaborate or long-reaching, but short-term goals are just as good. I remember a care provider likening goals in a care plan to a roadmap: we are the passenger with the map, supporting the resident to drive their journey.
Someone wanting to tick something off their bucket list
9 reasons why the CQC values evidence of service user progress
Considering the CQC's new single assessment framework, it is crucial to think about the new inspection process. Not being able to evidence goal setting or service user progression could lead to poor ratings of the care being given, reputational damage, loss of new work to competitors excelling in this area, and increased scrutiny and monitoring.
I have seen first-hand how the CQC like to see people progress with the support of their care provider. Putting on my learning disability provider hat, here’s a list of why the CQC values evidence of service user progress.
It not only evidences person-centred care, but also ticks off many of the Key Questions. The CQC sets the standards it expects. Being able to prove progress with goals is a key indicator of compliance, including Caring, Effective and Responsive. Positive risk taking can also tick the box for Safe and, done right, you will see the Well-Led ticked off too. How you evidence it all is the key!
It evidences high quality care, as you have staff who strive to meet the goals and aspirations of those you support.
It evidences continuous monitoring.
Involving friends, family and close circles around the person being support can evidence and demonstrate effective partnership working.
You can evidence positive impact which provides tangible evidence of the positive impact your service is having.
The CQC will see the people you support are empowered.
Knowing the goals of service users can allow you to allocate enough resources, including staff, to support and achieve them. Ensuring your teams are trained, upskilled, and have the resources to do their job can evidence to the regulator about staffing levels, training and resource allocation.
Capturing complaints from the people you support and those involved in their care. Putting actions into place because of these complaints can allow you to demonstrate continuous learning and improvement.
The CQC wants providers to ensure the long-term sustainability of care services. By assessing progress of those using care services, the regulator can gauge whether care providers are focused on achieving outcomes that contribute to the sustained health and wellbeing of individuals over time.
Remember it’s not just the CQC or service users you should think about, but also your team. It’s rewarding for your staff to achieve their goals, and it’s a chance to celebrate the person and the team involved. This can influence a positive organisation culture, and help develop strong working relationships, and forge lasting relationships between staff and those they support.
How can service users get involved in their own goal setting and progress?
If you do not currently support people to set goals, here are five easy tips to begin, although I would strongly recommend you reach out to other managers (or myself) who have experience, to ensure that you have everything covered.
Make a clear communication plan for your team, the people you support and their representatives. It is important that people are aware. Your team are vital to making this a success, so offer plenty of chances for them to ask questions and get clarity. Listen to their feedback and work with it, because if they are not onboard, it will never work.
Assign a key worker. This is the norm in learning disability services, but not always the case in older peoples’ care services. A key worker is someone who will become the person’s key contact, attend reviews and have the person’s best interest at heart. I would speak to each of the people you support and your team, and match the two. Done really well, this is a powerful tool. But done wrongly, this can be a catalyst for disaster. Ensure relatives are aware and use their feedback.
Does your assessment process look at goal setting? If not, review this and add it. Meet with each person and understand their unique needs, strengths and aspirations This information forms the basis for setting personalised and meaningful goals. Some people may need encouragement or support to identify goals for themselves, so ensure you have staff who are forward thinking to support with this. Ensure your team identify and build on the individual's strengths rather than focusing solely on deficits or challenges.
Encourage the involvement of family members, friends or advocates in the goal setting process. Support networks can provide additional perspectives and offer valuable insights into the individual's aspirations and needs.
Schedule regular reviews to assess progress toward established goals. This provides an opportunity to celebrate achievements, address challenges and make any necessary adjustments to the care or support plan.
How to monitor goals and track service user progress
Remember to celebrate both small and significant achievements. It is important that you document reviews and achievements to have as evidence for when you are inspected.
The old saying ‘if it’s not documented, it didn’t happen’ sadly means you could tell your inspector ‘til the cows come home, but if you don’t have anything in writing or evidence of this, they will not be able to use it in the assessment process of your inspection.
Here are some ways you could monitor goals:
Document the goal.
Conduct regular goal review meetings where progress is discussed, adjustments are made to goals if necessary, and feedback is collected. These meetings provide an opportunity to document progress collaboratively.
Incorporate surveys or questionnaires to gather feedback from individuals about their experiences and perceived progress.
Create visual progress charts or graphs that illustrate changes over time.
Capture before-and-after snapshots or videos to visually show changes.
Ask service users and your staff to write impact statements.
Encourage individuals to maintain journals or diaries where they record their experiences, reflections, and progress. Remember, you will need the person’s permission to share these during inspections.
Incorporate wearable devices, such as fitness trackers or smartwatches to monitor and record relevant health metrics.
Use health and wellness apps to track various aspects of an individual's wellbeing, such as physical activity, nutrition, sleep patterns and mental health. These apps can provide real time data and insights that contribute to personalised goal setting.
Look at telecare/telehealth systems to aid independence.
It's important to remember that goals have been proven to enhance overall quality of life by fostering a sense of purpose and joy.
You shouldn’t support people to set goals just because it will aid inspections. You should do it because, ethically, it is the right thing to do. It is the documentation of goal setting, and the reviews and impact of the goals, that should be what you strive to do for the inspector.
Found this information useful?
Sign up to Log my Care's newsletter for more social care insights and resources.