Comments on star ratings

Comments about star ratings

“Inconsistency of individual inspectors continues to be a problem, inspection report does not reflect true picture as one small “fault” is blanketed across whole standard” – A manager

“I believe that the system will create an effect rather similar to school exam league tables and in the scramble to try and gain maximum stars many important aspects of Care will go by the board. I certainly believe that CSCI is not the body which should be doing the starring for a number of reasons- not least because I don’t reckon that consistency is its strong point.” – An owner

“Although I agree with having star ratings, I believe that as in Inspection Reports interpretation of the standards is down to the individual Inspector.” – A manager

“As far as providers are concerned they will chase ratings and individuality will go out of the window.  Costs will have to rise to implement the star rating, and while I do not necessarily have problem with this I would much prefer any increases in fees to be put into care, training and raising staffing levels than perhaps bathrooms, decoration etc “ – A manager

“It will increase paperwork for managers so they spend even less time ensuring residents are looked after properly and their needs met.” – anon

On the whole the idea of Star Ratings is probably a good idea as everyone understands this system for the various other services such as Hotel standards, Restaurants etc.
However, all this will not change a few fundamental shortfalls in the way that homes are inspected. These are that

1) The system that is in place now has taken away the providers chance to reply to inspection matters that make the home receive a lower standard mark. ( as in our case with a new client who we had as an emergency placement and we had very little documentation to create a care plan- result a down grade on our care plans from the inspector as at that time it was considered incomplete!)

2) The Inspection officers view when attending to the actual inspection – this has never been a problem when it has been the same inspector as they have a feel for the home and its achievements, however, with the problems within CSCI and the changes of inspectors this will definitely result in differing points of view when inspectors call as they all have different views on what they would like to see and how it is documented. This again has been based on experiences where one inspector was happy to accept a paper format but was rejected when covered by an unannounced inspection by a different inspector!

At the end of the day it would seem that Inspections are much like a Cars MOT and are really only valid for the day upon when the inspection is carried out – a
manager

The star rating system is based on a moment in time and is at the discretion of the inspector.  There is a total lack of consistency between inspectors even the same areas.  The star ratings will give a false idea of the quality of a home.  I have not noticed a lighter touch just more bureauacy.  The CSCI would be better if they could provide guidelines for some documentation rather than keep changing their minds over what they want everytime a new inspector calls.  We have had to get rid of Investors in People and ISO standards (although awarded only 2 months before inspection) to comply with the new inspectors, copies of new systems sent and approved to the CSCI then when a new inspector calls they have said that we have no management systems and so given a 2 star rating.  This has all cost us a lot of time and money and has meant that the managers have to spend more time redoing paperwork to suit individual inspectors.  To help keep up consistency of care we recruited more seniors and then more communication and meetings was needed.  All this is escalating so that more staff, time and energy is spent to give a service which was a good efficient caring service and now appears to the residents and relatives that there are more people who treat them differently and therefore no consistency.  The Residents are at a time of their lives when going into a home is change enough and they want to feel safe, cared for and secure.  They dont want to feel that staff and their duties are constantly changing because of the whim of an inspector – an owner

Ratings will only indicate standard at time of ratings, and will therefore be out of date as soon as published (either home could have improved/deteriorated to alter the Rating). People viewing a home should make their own mind and not be influenced by an out-of-date rating – an owner

If I am taking a holiday I will not purchase before I have read up or researched where I am staying, I am willing to pay more for a higher start rating accommodation and resort.

This is how the future of care homes/villages and care providers should be categorised. If we are delivering a quality service this should be reflected in our rating, it is proof of what we are about. I would hope it would be awarded fairly and consistently – a manager

CSCI Inspectors are not always consistent in their demands.  They seem to have different views on what constitutes a “good care plan” etc – a manager

Star ratings should measure the delivery performance of good care and service. The star rating shouldn’t be measured against fabrics and buildings. Service users and their relatives choose for them to live in their selected home., regardless of ensuite facilities or not.
Not all service users use the internet, so therefore how are the star ratings going to be publicized? Will they be included in the homes inspection report? –a manager

The CSCI is failing to train its inspectors to a common/consistent standard The system of complaint/appeal is designed to block any proper investigation.
Given that Homes may be unfairly penalized financially by councilr purchasing elsewhere and the lighter touch will poor homes given good ratings will escape longer
– an owner

I feel there should be two ratings, one reflecting the quality care standard and the second reflecting the building environment. This is because a home can offer many extra stimulating features ie a snoezelen room, family kitchen etc but not have en-suit and this will reflect a poorer rating. Also what will happen to residents if they only want to live in a 5 star rated home?   A manager

My wife and I own a small home which I feel would have severe repercussions when the rating system is implemented. This is due to the property being over 100 years old and I feel we cannot do anymore to upgrade it. – Owners

The rating can only be fair if the organisation awarding the rating, have constancy and that they all work in the same way. At present CSCI are not always constant from one home to another. Depending on the inspector. A manager

I have stayed in five star hotels over the years and also two star.  As far as I could tell the five start hotels only had more facilities but I have had great holidays in two star ones. A manager

Generally I think ratings and availability of information re Care Homes standards is a good idea, but my survey above reflects the fact that I think the existing CSCI reports and standards are adequate, and should be built on. Generally, as with schools / hospitals, my view is start ratings can “dumb-down” complex quality services and inidividual issues, and vary dependent on date and time of visit, what is going on at a home at a point in time, and also the personal feelings of the adjudicator – A finance manager

I don’t believe star ratings can tell purchasers about the key positive features of our service. I have one Home, small personal touch, loyal long-serving stable staff team, great homely atmosphere, but unlikely to get four stars as I do not waste time generating useless paper, but use it supporting, training and supervising my staff. The CSCI Inspectors are likely still to focus, sadly, on the unimportant negatives, things we don’t do, rather than focus on the important positives which we feel we achieve well. And we can’t comment publicly in our reports – owner/manager

I believe star ratings may artificially boost standards as people ‘chase’ higher ratings rather than make decisions that will result in substantive and consistent improvement in car practice & provision. I am very worried that they will not be awarded fairly and consistently as although it is early days in the introduction of quality ratings we are experiencing considerable variation between inspectors. As with quality ratings and many CSCI reports, and I would emphasise that we receive very good reports, they will fail to give the full picture.  I can only say some of the most disappointing meals I have had have been in Egon Ronay rated restaurants!  – Quality and Compliance Manager

I feel that it is impossible to say whether the new star rating will prove advantageous or not. Whatever rating system is used there will always be a variance because each individual inspectors will have different points of view and agendas. In my company there are many homes with the same policies and procedures and although it has much improved in the last 2-3yrs some inspectors are still rating differently and asking for different things. The only way to have equality is to have one inspector for the whole country-impossible so we have to accept that whatever  system is used it will always be flawed. – manager

Care of the elderly is complex, caring for individuals effectively involves meeting their needs in the way they wish those needs to be met.  Individuals sometime want things they do not need.  A good home manages the balance by matching a resident’s needs and wants thorough effective care planning.  However star ratings will be awarded using a snap shot of the home’s performance and will then be the measurement of that home for 1,2 or even 3 years. 
Star ratings will result in a league table which on the surface benefits the larger organisations who can provide a package of care but not necessarily one that meets every individuals needs. 
It will not result in improving care of the elderly only standardizing it whilst encouraging even greater inequalities as the homes with more stars being able to command higher fees.
Owner

Concerned that star ratings won’t be consistent. Do the star ratings give a false impression of the service we provide. Don’t think that they will always be able to give the full picture of any one establishment. – A manager

Star ratings are very misleading. Just because a home does not have paperwork in place it will lose stars but may be a good caring environment. If we must have stars then an independent organization should award them rather like Egon Ronay for the catering business, then there would be no bias. I can’t see how star ratings would be of any benefit to anyone as those with the most stars would not necessarily be the best place to live. We would lose stars because of this old building but posh it not always homely.
A manager

I still worry that inspectors interpret the standards set differently depending on their own background and experience and this will follow over to the star rating.
Manager

Dependent on too many factors consolidated to achieve the level of rating. High star rating does not necessarily indicate a superior level of care. A smaller home may deliver a more intimate type of care although only achieve a low star rating due to lack of facilities. Too simplistic, “hotel-style” method. Additional pressure on homes.
– a manager

This could lead to people becoming to complacent, if visits are to far apart, minor problems could become major.
manager

Good that system gets reviewed, have concerns about the judgment of others to cast a rating. Concerns about rating levels and a care system that may lead to a rich/poor divide.
manager

Star ratings work well in the tourism industry as they follow pretty rigid guidelines. Assuming CSCI follow a national framework, this should be a positive step forward.
It should help small homes but any cost implication should not fall to the providers but to the regulators as it is they who want the system bought in.
– manager

With regard to consistency the tools that CSCI have designed for their Inspectors to use should enable greater consistency but practice is often very different.
executive director

I think the star rating is good but I do not like the wording. Will excellent be achievable? What are the different marks between the stars. Excellent /Good /adequate poor. Carers could be working to the very best of their ability, but due to other circumstances ( lack of input by provider lack of leadership skills ) they still may only achieve an adequate rating and this could demotivate staff and cause low self esteem or cause change of workplace which could cause further deterioration to the service offered.
– a manager.