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    This report reflects CQC inspection of Russell House that was done on the 9/05/2017 and on the 26/06/2017 was published which focused on standards of the government and the agencies responsible for implementation. Russell House which is a care home for individuals with epilepsy and accommodates twenty service users, hence the report was on quality management and the systems in place. 
    According to Freema (1983) explains that stakeholders are groups or people who are affected through achievement or success of organisation and can influence the aims of the organisation. The stakeholders experience the impact and effect of the organisation’s decisions that are made. There are internal and external stakeholders, Internal stakeholders include service users, organisations and staff. While external stakeholders include regulators, inspectors and various agencies like NICE and CQC. 

    Service Users Quality:
    This is considered in different ways concerning their expectations and experience. According to Sixma et al (1998) the important approach is whereby to explore the experience and the need of the service users, by listening to their views on quality from their experience of dignity and respect. Also, the care provided to them and the environment they live in whether it is favourable.  Service users’ quality assessment is connected to their relationship with staff and when their needs are met adequately. 

    The service users’ perspective is based on their expectations but not standards as in the case study, service users’ expectations were met. When they were asked during the visit of CQC, they said that the level of quality and care provided to them was of quality, staff were empathetic, their request was attended to and there was good respect towards the service users by the staff. 

    staff perspective of quality is in relation to the expectation of adequate facilities and adequate working condition to do their role in a proper manner. In addition, employees are concerned about their rate of pay, salary and working hours hence determine the perspective of quality. According to ASQ (2017) staff   consider empowerment and fear of working a good environment and to continue with
    improvement through training staff as part of staff perception of quality expectation. In the case study of RHC, there was quality to some extent as staff were happy with the work, however not with the level of staffing. The staff who were brought from agencies were not having adequate skills that the permanent students had, therefore pressure was increased on permanent staff because they find them in the situation of doing more work. Therefore, there is a need to improve on staff recruitment to resolve this problem. 

    CQC quality perspective ensures regulations and set standards are practiced and standards from different agencies that include: CQC, NICE, NMC and sectors Skills Council.  CQC considers quality from perception of services implemented and ensure them to be effective, safe, high quality and improvement which is continuous (CQC, 2015). Quality is accurate, have adequate budget for quality services, good record keeping and correct documentation.  Therefore, in the case study CQC perspectives were partly implemented, however in some cases staff were ignorant about service users’ needs hence not meeting quality perspective. Therefore, there is a need for continuous monitoring of quality of services by CQC. 

    According to Health, Social services and public safety (2014) external agencies are referred to regulators that work for government, influence performance of the organisations to ensure they comply with legal standards including quality. They provide warning notices, termination when an organisation fails to comply with regulations, encourage and provide advice to organisations. 
    There are different external agencies like: NICE, CQC, NMC, Health Commissioner of midwifery and CCG.

    The role of three of the above will be explained as below:
    NICE (2015) it’s the role of NICE to provide advice and information for improvement of health and social care services. They also set up standards to enable improvement for the outcome of the people and the public using NHS services and it is through provision of guidance, advice and information and establish advice and direction for health and social care workers. Coulter et al (2013) suggest that they produce standards of quality measurement for commissioners, health and social care officers, to improve health and social care service delivery. 

    For example: In the case study of RHC, NICE standard includes the administration of medication, because it was reported that allergies due to medication were not reported by staff, hence non-compliance with the standards. However, the manager made improvement by taking immediate action hence the residents’ needs were met as it is NICE standard.

    Care Quality Commission (CQC) refers to the system regulator and they have a role to make sure that safety and quality of care is met by the social care providers in England (RCN, 2008). CQC monitor and checks facilities whether they meet the required standards.  Also, CQC, inspects organisations and publish the outcomes or findings and rate the performance to enable people decide on access to health care services (CQC, 2017). 

    Considering the case study, CQC role was evident through registration of RH and the manager was registered hence were meeting the requirement of Health and Social Care Act 2008 and regulation (CQC, 2015). For example: it is the role of CQC to inspect Russell House. In the case study, training was provided to staff, however two staff were overdue to have training and did not sign to confirm they read relevant report to promote care appropriately. Nevertheless, pressure that was experienced by staff was reduced, CQC improved on their rating on the standard although identified areas of improvement. 

    Therefore, there is a need for continuous inspections by CQC to ensure standards are practiced as required. 

    Nursing and Midwifery Council (NMC). This body was established to protect the public and obtain this through being a watchdog for midwives and nurses in England, Scotland, Wales and Northern Ireland. They determine professional conduct, standards of education, knowledge and skills, performance of midwives and nurses to deliver quality care as required by NMC standards. They register nurses, investigate on indicted midwife and nurses. However, in case they find there is ground of non-compliance, they can remove the professional or nurse from the nurses register here is ground, they could take such professional off the nurses’ register following the standard. 

    Therefore, external agencies must continue to work in collaboration and ensure the implementation of the health and care quality standards are achieved.  CQC to set and maintain quality standards of the organisation, NMC to ensure professional quality and conduct of nurses and midwives and monitor their training and skills. NICE ensures promotion of medication and nutritional standards and provide guidance. 
     According to Foster (2010) the poor services caused by lack of funds or necessary facilities to meet service users’ basic needs or to enable the provision of quality services by the organisation. 

    Poor quality of care is provision of inefficient, unsafe, ineffective and not patient centred care and can have a negative impact on stakeholders like staff, service users, monitoring bodies and organisations and management. It can also lead to loss of business and funding. 

    Poor service quality is where a person or organisation does not meet the set standard, expectation and not delivering expected quality as required by the framework (Kingsfund, 2016). If there is poor quality of service, stakeholders like service users, staff and organisation face the impact especially in a negative way and service providers realise poor quality of service. 

    Service Users:
    The impact of poor service quality on service users will lead to the loss of trust because of reliance and expectation of the services (NCBI, 2014). Dissatisfaction of service users will lead to demotivation and unhappy, depression, deteriorate health, service users to become more vulnerable. It would also increase bad health condition, increased risk and lead to death in some cases. In the case study of RUH, there was no major significance of negative impact on the service users as they said that they were happy about the care provided to them. Service users said that staff and manager were good. 

    The impact on staff include: demotivation, decreases self – esteem, depression, and more mistakes. Staff become demotivated due to the impact of poor quality services and reduce their morale and confidence. This may lead to possible potential job loss, errors in performance, being absent from work and will increase complaints (Raza, 2014).   Serious mistakes can lead to legal or court proceedings that can result in custodial sentence and fine. According to (RCN, 2017), culpability may affect registration of doctors and nurses. It can result to anxiety, stress and depression. RH had a lot of staff vacancies, instead used agency and bank staff to cover the shifts. Hence, this put a lot of pressure on the permanent staff and this can force good staff out of the job at RHCH because of impact of the poor-quality services. 

    Organisations experience the impact of poor service quality because the organisation’s reputation will be negatively affected.   This can result in the decline of service users because they may decide to leave which could affect profit and income generation.  Also, there will be staff turnover because the staff would leave due to anxiety of potential job loss, termination and suspension. There will be loss of good employees because the environment may affect their performance (Deeprose, 2006). The cost of operation will increase due to staff recruitment and training staff. Therefore, the impact can be bad reputation, increase staff turnover and increase costs among others. 

    Therefore, to avoid negative impact on stakeholders of the organisation, there is a need for proper recruitment system, training and monitoring. This system will reduce shortcomings and have measures for continuous quality care. 

    Standard refers to a concept applied as a foundation for judgement and a way of measuring or benchmark the quality of services provided to service users (Wang, 2011). Standard increases quality of care services provided and it’s the responsibility of the care providers to ensure that provided services meet the legal standards set by regulators (NICE, 2017). Code of practice promotes independence of service users while protecting them, by carrying out risk assessment and use of care plan. However, in the case study of RUH, service users were not supported because care plans were not followed. There organisations which set standards in health and social care include: CQC, NICE, NMC. 

    CQC is a regulatory organisation and set standards on how to deliver services and maintain safe care for the service users. CQC standards are based on priorities like safe, effective, caring and ensuring that services provided meet the needs of the service users (CQC.org.uk, 2017). For health and social care organisations to meet CQC standards, they need policies and procedures in place to be able to promote safe, effective and caring for the service users. All these, are to ensure that the patients or service users are treated with dignity and respect, involving them in the planning of their care and treatment so that they are aware of how their services are done. Also, to seek their permission before invasive treatment or care is provided, ensure they get correct and safe services which meet their demands and needs (CQC. org,uk, 2017).  However, relating to RUHC, some services met the CQC standards, but CQC reported some problems which they have to address like a need for monitoring, care plans, recruiting more staff, skills and competence and have to provide relevant training for staff to enable them identify the needs of the patients and service users. 

    NICE is an organisation that established standard in health and social care through partnership working with health and social care providers. These are to guide them on better practice, update them on changes and innovations to help them improve on services and to maintain high quality of delivering care services (NICE, org.uk, 2017). It is concerned with Nutrition guidance of service users on how to feed them and use of fluid chart to be maintained to meet NICE standards. NICE quality standard promotes the profile and showcase the importance of health and social care and serves as benchmark in improving the quality of care services (NICE.org.uk, 2017). Considering the case study of RUH, NICE standards can be used to improve services and amend areas to be addressed by CQC report like effective communication, better ways of administering medication, and record management which will improve on the quality of care services. 

    NMC has set standards for the nurses and midwives to ensure that they maintain better level of conduct. NMC standards promote professionalism and trust, education for Nurses and Midwives and investigate any complaints made about nurses and midwives. The standards set by NMS ensure Nurses and midwives have adequate and update their skills and knowledge regularly in order to maintain high standard of delivery of services. NMC requires nurses to carry out their responsibilities effectively and efficiently, promote competency and maintain safety (NMC, 2014). However, considering RHCH, it was reported that there was lack of adequate training which affected the performance of the staff. For example: staff failed to identify the needs of the service users, there were no proper documentation and lack of continuity of care. All these can expose service users to harm and danger because of the errors. 

    According to Saul (2004) quality system refers to a structure for managing the manufacturer’s quality of output. When there is good quality of system it prevents problems from happening instead of correcting them later when they have occurred. quality system is a structure for managing the quality of the output of a manufacturer. Quality management systems set up by organisation include: Total Quality Management), Quality control, Continuous Quality Improvement, Quality assurance and Benchmarking. 

    Benchmarking:  this is for applying system, measuring the performance of the organisation with internal and external standards which may be applied to obtain quality system (Saul, 2004).  Continuous quality improvement refers to a management philosophy which organisations use to increase efficiency, internal employees, customer satisfaction and to reduce waste. According to McLaughlin (2006) CQI is continuous to evaluate the ways an organisation performs and measures to improve the process. It aims at improving the process of the company to be efficient and improves the morale of the staff to improve on the productive of the company, in this case many workers will not leave their jobs. It reduces turnover her and this is vital especially for small business as the owners must recruit and train new works by themselves to equip them with skills. 

    Considering training employees is expensive, takes money and time yet important for continuous improvement environment. Also considering time already spent training new employees to perform their tasks as required by the job. This process leads to the new employees to be tired and takes long. Organisations which want to improve must change the ways of changing business by working adequately. 

    Ross (2017) suggested that Total Quality Management (TQM) refers to a competitive approach to long term success. This is delivered to the satisfaction of customers and in TQM, all employees in the company or organisation try to increase services. Also, products and internal culture to produce the business process which deliver improved experience of the customer.  

    The advantage of TQM includes costs reduction of the organisation especially in the areas of field service, warrant cost reduction, and areas of scrap. However, there also disadvantages like Resistance of employee especially when the TQM needs change in methods of performing the job, change in mindset and attitude. In this case if the management fails to communicate effectively to the staff or team approach of TQM, the employees may become fearful and this leads to employee resistance. This means that when workers resist against a program or change, it reduces the morale of the employees and lower productivity of the organisation or business. Therefore, TQM uses small incremental improvement for the business to go forward and may take more years enjoying the benefits from the program. 

    PDCA stands for Plan, Do, Check and Act. This is a four-step management method that is used in business for the continuous and control improvement of process and products. In this case the organisation must create objectives, process, plan and implement, suggest measurement based on results, apply changes. The organisation must establish objectives and processes, implement the plan, decide up measurement the results, and then apply changes based on results. Therefore, organisations must change to improve on the quality. 

    Also providing training and resources and setting targets will be good for implementing quality system at RHCH. All these will enable staff to perform better and meet the targets, make progress, get new skills and there will be better and adequate resources. 

    Therefore, quality management systems like TQM are very important for the performance of an organisation.

    Bullard (2006) explained that barriers referrer to anything that make it difficult for a person to do something. There are various problems when delivering higher services in health and social care.  These factors include: limited access to training, heavy caseloads, and limited resources. People may not be aware of challenges a person faces at the job. 

    Level of Staff: This can be a barrier and result in reduction of quality of services provided, added stress and pressure on permanent staff, dissatisfaction, and complaints from service users. For example: at RH staff said that working with agency and bank staff increased pressure because permanent staff were responsible for extra shifts. Level of staff was also reported by some relatives that some agency and bank staff had inadequate specialised skills and knowledge to meet the service users’ needs.  It created a gap in the service which was resolved by management by recruitment of more permanent staff. 

    Lack of communication may be a barrier resulting in some mistakes and lack of quality care, which can lead to fatalities and incidents. At RH, there was a case whereby a member of staff did not know the guidelines concerning the care plan of a service user in relation to feeding routine that may lead to the risk of choking. Lack of information could have led to risk of injury as carer escorted service user on trips. However, the issue was reported to registered manager and took immediate action to address the issue. Professionals must be honest and open, use effective communication as the required core skill at Russell House care home, to ensure they meet the service users’ needs. 

    Lack of Leadership in delivering of quality is one of the potential barrier. Stable leadership is important for service improvement in health and social care organisation, because effective leadership promotes integrated care. Leadership can improve on proper communication in an organisation, provides workers or employees with support they require to implement their responsibilities and to resolve problems.  However, when there is lack of leadership as it was reported at RUH by CQC, patients and organisation face this barrier as there was lack of monitoring, observation and supervision of staff (Health policy and Economic Research, 2012). 

    Therefore, it is crucial to eliminate barriers for effective delivery of quality services. This will result in customer satisfaction, increase efficiency, productivity, and better outcomes for stakeholders (SCIE, 2016). 
    According to Coleman (2012) systems refer to interdependent component which works together to achieve the aim of the system that reduce or minimise waste. While policies are principles which guide operation and lead on the way of achieving organisation’s objectives. There were various policies and systems at Russell House to achieve the aim of the organisation like HR Management, communication, medicine management, monitoring, documentation and recording, complaint management, risk and accident management. 

    According to Bartle (2011) Monitoring refers to regular data collection in various areas of operation that is done by systematic observation and recording continuous events of the project. At Russell House, monitoring system enables the organisation to identify minor problems before they become major and to project on the future using the identified information (Ligus, 2012). Monitoring helps in the delivery of quality services. However, the system that is in place is not regular involved in because auditing was not done at the required intervals. If this was done properly would have enabled the management at RH to identify the gaps that were in the records. Monitoring at RH, to some extent was effective as there was infection control audit and health and safety, but care plans were not audited regularly. Nevertheless, auditing medication was done but not on regular basis in some units. But on page 9 of the report, staff carried out regular checks to ensure the fire equipment was in good order. Fire drills took place. The fire equipment, lift, gas safety, electrical appliances and fixed lighting were regularly serviced.
    Therefore, there is a need to use monitoring system effectively to continue practicing the system as required and reduce problems. 

    Quality Auditing System, in the case study on page 17, it is evident that the provider was in breach of Regulations 17 of Health and Social Care Act Regulations 2014. This was because records were not dated, accurate and completed.

    Management of medication policy and systems were practiced at RH. NICE (2017) the guideline on medication by NICE requires that medication care for people, support to ensure correct handling of medication and safety, administration and disposal. In the report by CQC inspection, it was noted that one of the service users had allergy to some medication. However, some staff did not have knowledge on allergy hence causing life threatening or even death to service user. 

    Medication policy was effective at RUH, because some staff had training in administering medication and were tried to ensure that they were able to administer medication. Staff were observed and supervised fifteen times to ensure quality service for the service users. Nevertheless, there was instance whereby one staff who was not aware that a patient had allergy to medication. For example, on page 8 of the report, medicine was administered in a disguised format without the knowledge or consent of the person receiving them. Also, service users were at risk of choking, risk of injury to themselves and others.

    Human Resource management procedure and policy was in place, however there is inadequate staff according to CQC report. Staffing standards according to regulation 18 of health and social care Act 2008, regulated activities require competent and qualified workforce to be available to deliver care that meets the service users’ needs (CQC, 2017). However, RH did not have adequate permanent staff during the time for CQC inspection hence breach of the regulation. They had agency staff to supplement to deliver services. Therefore, this means policy and procedures in RH were not effective as there was inadequate staff, not enough trained staff and there was a lot of vacancies. On page 16 of the report, some relatives raised concerns about the lack of staff willing to drive the minibus which they felt impacted on the community access.

    RUH was using agency and bank staff but not meeting the quality service of the organisation, pressure on permanent staff, and making the system in many ways not effective.  The Mental Capacity Act was not implemented well. People were not always supported by regular staff. The permanent staff told CQC they felt under pressure when working with Bank staff. The recruitment process of the staff was inefficient, However, on page 13 people's bedrooms were personalised. They were decorated to their taste and reflected their interests. People's Care Plans outlined their communication needs.

    Therefore, RUH needs to make improvement on what CQC included in the report to improve quality services.
    According to Spiegel and Backhaut (1980) there are various factors which can influence achievement of quality care standard like external agencies, choice and control, quality system, healthy environment, leadership, funding, communication, monitoring, ethical and moral standards, culture, knowledge and skills. Various factors which may influence the quality goals at Russell House that include: environment, effective communication, patient focused activities, 

    Staff training and skills   acquisition is a factor because quality staff team result from continuous training and career development planning for maintaining and ensure satisfaction of service users (Wagen, 2005). Knowledgeable staff are aware of their duties to meet the standard expectation of quality hence reason for the service improvement. Customers associate quality of service with the provider of the service, when staff motivation and staff development are considered as priority hence facilitating customers’ expectation (Wright, 2008). Low staffing level at RH reduces the service quality, however they are in process of recruiting more staff and fill the vacancies as reported by CQC. Nevertheless, the service users and families told CQC that permanent staff were well trained. 

    External agencies are important in playing the role which influences quality standard of care and provide benchmarking and guidance to health and social care organisations. This helps in implementing regulatory requirements, identify, improve and to maintain quality standards. For example: this can be done through training and adequate staffing. However, at RHC, there was inadequate staffing, inadequate staff training as staff had low level of knowledge about principles of Mental Capacity Act and Deprivation of Liberty safe guarding as reported by CQC.  Also, Clean environment is important to prevent the spread of infection, bacteria and disease. It may lead to absence of staff due to sickness, endanger lives, increase in complaints, increase costs of staffing and reduce quality care. However, RHCH had a vigorous system of cleaning schedule for house keeper and reporting repairs. 

    Quality systems are very crucial factors which influence achievement of quality standards and are guidelines for staff to practice regulatory requirement which govern health and social care organisational activities. It is useful for RUH in delivering care services which meet the regulatory standards. Nevertheless, it should be a combination of all the factors like quality systems and policies, workforce culture of care workers and managers that influence achievement of quality standards. 

    Therefore, it is vital for the staff at RHC to show motivation to provide quality standards of care, compassionate, passion and duty of care. Considering the case study, medication audit was inadequate in some areas and not administered in time (Gilpatrick, 1999). 
    According to Hughes (2008) service quality improvement refers to support that is continuous in health and social care and it is to reduce problems and increase productivity and motivation of employees. However, during CQC inspection, they realised some problems which required to be addressed such as staff level, staff training and record management among others.
    Staff Level
    RUH had several staff vacancies but used bank and agency staff to cover the vacancies to maintain the required staff level. Agency staff were working in all units which lead to pressure on permanent staff and people being supported by staff they did not know. The provider was trying to recruit into the vacancies and new staff had been appointed to address the inconsistency in care. According to CQC report on page 3, the permanent staff felt under pressure when working with Bank and Agency staff as they felt that all responsibilities of the shift were to be done by them. In this case I will suggest that RH begin the recruitment process to improve on staffing to the required level. This means the recruitment team (HR) need to advertise jobs to fill the positions or vacancies and improve on the salary to attract more skilled and quality employees. I also suggest that there should be consultation to ensure the staff wages are reviewed. 

    Staff Training:
    Staff training is important to enable staff have skills and knowledge for better performance. According to Health Foundation (2012) quality improvement training is an activity that aims to teach professionals about the methods which can be applied to improve and analyse quality. In the case study of RUH on page 8, there was inadequate training. For example: a staff member involved in medicine administration was not aware of the allergy of one of the service users. This needed to be addressed and added to the medicine administration record immediately. At RUH, people’s care plans outlined the support required with their medicines, but one person had the medicine administered covertly. This meant that medicine was administered in a disguised format without the knowledge or consent of the person receiving that medicine. I would suggest that staff training at Russell House must be a priority to promote and maintain quality in health and social care. This will enable staff to administer medication appropriately. There is a need for people’s care plans to outline the support required with their medicine. I would suggest that at RH, training must be in different ways like induction for new staff to learn about the ways of providing quality services to be done on the first day they start the job. Also, permanent staff must get both internal and external training to update themselves with new policies, practices and skills.  Therefore, when staff are trained in quality improvement, they will be able to improve their attitude, skills and knowledge. 

    Record Management:
    Medicine management and medicine records accurately reflect people’s allergies to medicine. A medicine policy and guidance were in place to guide staff, however, one person’s care plan indicated they were allergic to medicine. Nevertheless, this was not recorded on the person’s medicine administration record by the staff. CQC identified that RUH did not have proper records in place and communication. Therefore, staff must comply and record all activities, incidences and accidents for proper record management and accountability. 

    Staff had access to training at RUH as the provider considered mandatory aspects such as epilepsy awareness, fire safety, food hygiene, first aid, health and safety, safeguarding of vulnerable adults, and moving and handing. Alongside this, staff had specialist training in managing challenging behaviour, autism, learning disabilities and mental health. The provider had changed the frequency of their training and whilst several staff had been trained, however, updates in training were overdue and not yet booked. Nevertheless, this was being addressed. I recommend that RUH must carry out appraisal, supervision, review, identifying the impact of quality of services provided and areas for staff training. 

    In conclusion, health care sectors like RUH must ensure the provision of person-centred approach to ensure that quality of care meet the needs of service users. Practice procedures and policies while delivering services at RUH and improvement of quality by maintaining proper record management. Training staff and organise meetings, planning and implementing quality services. RUH must improve on the staff level, staff training and record management. 
    Evaluation is a way of determining the worth and importance of using benchmark guild through a set of quality, it is vital in health and social care since it is useful in clarifying the aim of the activities. In addition, it helps to determine the responsibilities through identifying consistency of quality and better outcomes.  It is a process that is used to examine the activities of the organisation, collecting and analysing information from activities and programs of the organisation like RUH. It is to get an understanding of activities and improve on effectiveness (Cowley, 2007). 

    There are various methods for evaluating quality of health and social care like internal (RUH) and external (CQC). Methods of evaluation include: questionnaires, surveys, interview, focus group, feedback and observation. Evaluation can be done by internal stakeholders like the manager of the organisation (RH) and external stakeholders like CQC by doing surveys, use questionnaires and interview.  Therefore, the methods include: quality audit and Review, Quality inspection, quality sampling, quality tour, and quality survey.

    Quality Inspection is carried out by external stakeholders like CQC in health care sector. This is to determine legislative and the quality standards compliance. The advantages of quality inspection, improves quality standards, keeps the organisation on track, ensures proper records for health and safety, training, up to date staffing and suitability of the environment. Health and social care organisations identify where to improve and comply with the requirements of legislation. Considering the case study of RUH, CQC inspection discovered several issues like lack of training, inadequate staffing level, inadequate record keeping and management and communication. However, quality inspection has disadvantages. It might fail to get a clear reflection of an organisation’s conduct because unsafe practices may not be disclosed (Oleske, 2012). 

    The questionnaires must be used by RH as a method of evaluation. This is a research tool with structured questions like (Yes/No, agree/disagree) that is used to collect information from respondents. In case of RH, questionnaires can   be distributed to staff, service users and relatives to get their opinion and the information will help RUH to improve the quality of care services and make improvement as required and where necessary. Questionnaires will help RUH to measure the opinion, attitude, preference and behaviour of the people. It is important to get accurate data on the services provided and as perceived by the service users and enables the improvement of the quality of services and focus on other business opportunities (Health knowledge, 2014).  However, sometimes it can be difficult to validate questionnaires because of complexity of the information collected. Also, the respondents can be dishonest and provide wrong answers or to withdraw information because of their privacy. 

    Feedback is crucial as a method RUH can use to make important decision. This will be beneficial to RCH in improving delivery of quality service. RUH can use a form which is designed and used to get feedback or information to improve services and enable the organisation to develop policies or amend them. Also, to enable RUH to weigh their strengths and weakness and also get measures to address the problems identified by CQC. RUH can use information from feedback to maintain good communication with service users and staff productivity. Nevertheless, it requires a lot of resources and very costly. Also, some people may be dishonest when completing the forms, hence invalid information (Rock, 2007). 

    In conclusion, I suggest that the best method to improve quality of the organisation in the case study is Quality inspection and use of questionnaires. QI will help RUH to do routine check and measure the quality standard development procedure of the services provided and compare whether they meet the standards and compliance. CQC inspection revealed that RH needed to address some issues to maintain better quality. I believe quality audit will be beneficial in achieving the standards and ensure planned activities are done properly. Therefore, the information from the questionnaires will be crucial for RUH to improve the quality of their services by reviewing their mistakes, because it will be direct information from the service users. 

    Service users’ involvement in the evaluation process is crucial for the improvement of quality services at RH and in health and social care organisations. Service users are stakeholders and must contribute to the planning and how their services must be delivered because they have knowledge on the services they want which meet their needs. RH must involve service users in evaluation and in decision making so that they feel valued, empowered and respected that enables them to be in control of their care. Involving service users has major impact on the ways quality evaluation systems of the services they receive to be organised and designed (Becker et al…, 2012). Therefore, patients’ perspective of care is crucial to improve quality of care. There are advantages and disadvantages of involving service users in evaluation as below: 

    Advantages of patients’ involvement in evaluation process at RH is important because it increases self-esteem, empowerment of service users, enables them to voice their opinion and decision-making about their services. Also, this meets the person-centred approach and good practice of standards. Chapman et al…, (2011) suggests that service users’ involvement in the evaluation process will improve on 

    transparency of sharing information with carers, patients and relatives. The service users of RUH will have an opportunity to be valued, enhance treatment outcome, get more involved and have a sense of ownership of services. 
    However, they are disadvantages of involving patients in evaluation process at RUH. The service users may be demotivated to join the evaluation process due to lack of self-esteem. Patients at RUH may fear the evaluation process because it might affect their care planning and treatment. However, Taylor and Francis (2002) explained that they may fail to consider the process when there is ineffective information. 

    There are strategies that RUH can apply to involve service users. RUH must consider involving carers, patients, family members and parents. RUH must advocate for vulnerable patients and those with mental capacity, consulting them on their services and changes, and involve them in decision making about the services (DH, 2010).  Effective communication is important to be able to meet the strategies. RUH must communicate to service users when planning to ensure that strategies meet their care plans and must consult them before strategies are implemented. While service users must be involved in development and review of services, however, RUH must monitor, access relevant training and support that would enable service users to engage in the plan and responsibilities at RUH. 

    In Conclusion
    Managing quality comprises a lot of activities and several stakeholders, however the health and social care sector must develop the right procedures and policies to enable them to manage the organisation like RUH. Health and social care organisations must to improve services and cope with new changes hence, it is important to improve quality. Also, organisations like RUH must implement the standards set by external agencies such as NMC, CQC and NICE. RH must get feedback from the service users and use the information to improve quality of services and evaluate