Care Home Manager accountability – legal vs organisational. Never the twain shall meet?

First Published by

Liam Palmer, Elderly Care Specialist, Leadership Coach and Author

May 10th 2018 on LinkedIn           


One of the things I love about the development of the CQC legislation
on “registered manager” is that the individual is held to account for
what happens in their home – by omission or commission, they will answer
for what occurred. I love this because it encourages ownership and
fosters leadership. I love that the buck stops with this person. They
are empowered. It is a good thing – responsible and forward thinking yes
BUT what about the rest of those above the home manager? I know there
is a responsible nominated individual assigned who will also be held to
account it comes, what about those in the middle?

Before some unscrupulous readers assume a negative intent here –
there is none. I have worked for and served many care home groups with
some remarkable senior managers in place. I am simply making the point
that regardless of their ability there is a slight disconnect between
the home managers with legal accountability and those more senior
managers who make decisions about direction / resource allocation without this responsibility.
The CQC is aware of this and reviewing this matter. In the meantime
here are a few thoughts about the limitations and vulnerabilities of the
current system;

The registered home manager is fully responsible for taking action to
ensure the home is compliant but what if those above do not offer
support – how does the registered home manager exercise their
responsibilities then? What do you do if the support structure doesn’t
agree to what’s needed? This is where the legal vs organisational
accountability conflict occurs. I wonder if the care home management
structures have evolved sufficiently to enable the registered managers’
to do their job?

The least effective support structures I’ve come
across have had the following characteristics – senior managers holding
the RM accountable to extreme levels of rigour, without any
accountability themselves and occasionally with passive aggressive
behaviours. I’ve encountered senior managers being subjective without
reviewing any objective data at all – e.g. well designed and executed
audits or detailed resident and staff feedback. In my view, the inherent
problem with this type of support is the lack of focus and objectivity.

The most effective support structures I’ve come
across are just that – plainly support structures both by intent and by
design. They have a spirit of support woven in. They are in response to
the complex job of running a service compliant with the CQC KLOE’ (key
lines of enquiry – is the service well led, effective, responsive, safe,
caring?)s and make it easier for the RM to do so – usefully
highlighting areas for adjustment / improvement. I know some groups do
full mock CQC inspections with very good actual CQC results after. There
is a lot of great practice out there.

To conclude I think the sense of ownership intended by this CQC
legislation focus is helpful but it needs to be married to a sense of
support and an effective and responsive management structure above the
registered home manager for optimal results. That way organisational
accountability and legal accountability are aligned. In the end,
decisions about the service should reflect the needs of the residents it
serves. As an industry we mustn’t allow politics to get in the way of
great care.

In my view, we are all accountable aren’t we?

Published by Residential Forum

The Residential Forum is to promote the achievement of high standards of care and support for children and adults living in residential care and nursing homes, supported housing, residential schools and colleges, hospices and hostels. It contributes to improving the quality of service to the public. Members of the Forum are people of standing and experience drawn from the public, private and voluntary sectors, as well as some who can speak for service users and carers.

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