Methods

Telephone surveys were conducted with staff in care organisations who had responsibility for training or induction of care staff.

5.1.1 Sampling Strategy

The sample was randomly selected from organisations listed in the CQC Care Directory (CQC, 2016). This directory contains details of registered care organisations and their managers, and allows filtering by regulated activities, service type and region. This database is publicly available under the Open Government Licence. A total of 30,311 relevant CQC- registered care organisations (hospitals, social care organisations and independent

providers) were identified from the initial sampling frame. The sample was stratified by region (North, Central, South East, South West) and type of service (Health Care, Social Care and Domiciliary Care), and proportionate selection was used to ensure that the sample in each strata was proportionate to that of the total population.

Probability sampling was used to randomly select the sample of care organisations to fit the stratified sampling frame. A sample size of 400 gave a margin of error of 5%, i.e. for each of the reported survey results we could be 95% confident that the total population’s score would fall within +/- 5% of that of the population. With a total of 400 providers planned to be interviewed and, assuming a 50% response rate along with the possibility of inappropriate organisations remaining within the final sampling frame, 4.0% of the total population in the CQC database were selected to be approached for telephone interview (n=1203).

A number of inclusion criteria were specified for the population of providers. These classifications are below.

Classifications Supra-regions

• North: North East, North West, Yorkshire and The Humber • Central: East Midlands, East of England, West Midlands • South: South East, South West and London

Type of service

• Health care: NHS organisations, independent healthcare • Social care: social care organisations

• Domiciliary: any organisation within the other two domains (health care or social care) which provide domiciliary (home-based) services

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Of the providers listed in the CQC database, organisations were excluded if they did not provide any one of the following activities regulated by the CQC:

• Accommodation for people needing nursing/personal care

• Accommodation for people needing treatment for substance misuse • Treatment under the MHA

• Nursing care • Personal care

• Treatment of disease/disorder/injury

Advice was taken from a member of the PPI group that organisations solely delivering some specific services would not employ sufficient numbers of non-registered care staff for the purposes of the study. These included services such as transport, slimming, dental, and remote clinical advice.

NHS healthcare organisations

The CQC database registers organisation by the geographic location of the management of activities which are regulated by the CQC. For a number of large organisations, in particular NHS Trusts, this means that multiple sites within the same organisation are registered within the database.

In order to ensure that these sites could be treated as independent sampling units, advice was taken from the project steering group with regards to Care Certificate training processes within NHS trusts as well as learning from a previous NIHR HS&DR funded study (the CHAT study), and a pilot with a small number of organisations (n=10), including two sites from two NHS Trusts. It was found that the implementation between sites within the same NHS organisation differed sufficiently for these to be treated as independent sampling units.

CQC Dataset

The database of care providers was retrieved on 08/06/2016 from the CQC website1_{, which} provided data from the CQC database as at 01/06/2016. The total number of providers registered on this date was 50,001. Meanwhile there were a total of 30,311 organisations providing the type of services meeting the inclusion criteria of the study. There were 7 organisations with an unspecified location. Table 1 shows the total population of included care organisations stratified by region and service type, with percentages.

1 _{CQC Data Directory http://www.cqc.org.uk/content/how-get-and-re-use-cqc-information-and-} data#directory

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Table 1. Number (percentage) of care organisations in the population by region and service type (n=30,331)

Service Type Number (%)

Domiciliary Health Social Care

Region Central 2832 (9.3%) 1269 (4.2%) 5260 (17.3%) North 2148 (7.0%) 1321 (4.4%) 4531 (14.9%) South 3490 (11.5%) 2260 (7.5%) 7173 (23.7%)

Using this stratification, a target sample of 1203 organisations was drawn from the population, equating to 4.0% of the total population as shown in Table 2. These 1203 organisations provided the sample who were approached to take part in the telephone survey.

Table 2. Number (percentage) of care organisations in the target sample by region and service type (n=1203)

Service Type Number (%)

Domiciliary Health Social Care

Region Central 112 (9.3) 51 (4.2) 209 (17.4) North 85 (7.0) 52 (4.3) 180 (15.0) South 139 (11.6) 90 (7.5) 285 (23.7)

Figure 2 shows how the final sample size was obtained from the initial population obtained from the CQC database.

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Figure 2. Flow Diagram of Population to Final Telephone Survey Sample

5.1.2 Telephone Survey Procedure

1203 organisations were initially contacted from the CQC database. Research Assistants (RAs) worked systematically through the list of contacts, each RA starting at a different part of the list. Figure 3 depicts each stage of the process of contacting, arranging and

conducting the telephone survey with participants. These stages were not necessarily distinct and could overlap (e.g. stages 2 to 4 may occur over the course of one telephone contact). Full details of the contact procedures for the telephone survey are detailed in the standard operating procedures for the study (Appendix 4).

The process involved the researcher obtaining the key contact’s details and introducing them to the study and the purpose of the telephone survey. The researcher recorded the routes taken to obtain contact, methods and volume of calls required in order to identify and engage with the most appropriate person for the interview. Name, job title, telephone number, email address were recorded onto the database. If the contact was willing to take part in the

survey, the RA arranged a mutually convenient time for the interview and recorded this in the Telephone Survey Contact Log. After obtaining the key contact’s details, the RA emailed the participant with a letter of invitation and the participant information sheet. The researcher followed up a week later with a phone call in order to confirm receipt of the email and to book a suitable time for the telephone interview to take place. If the participant was not available at the agreed time, the RA was required to call again on another occasion with a view to rearranging the interview. All new arrangements were recorded in the Telephone Survey Contact Log and appointment diary. In the unlikely event that a participant was unable to

Providers meeting inclusion criteria (n=30,311)

Stratified sample of 4.0% of population of providers (n=1203)

Responses from sample of providers (n=401)

CQC Directory of Registered Providers (n=50,001)

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complete the interview once the RA had made all reasonable attempts to complete the interview at the mutually agreed time, or where a mutually agreed time was not possible, the RA thanked the participant for their interest in participating in the study, where possible, before discontinuing. The RA noted the inability to complete the interview in the telephone survey contact log and telephone survey interview log. All organisations were contacted up to a maximum number of five times before being removed them from the sample.

Figure 3: Telephone Survey Flow Chart

Participants wishing to take part in the telephone survey were firstly asked to confirm whether or not they had received the participant information sheet. If so, participants were asked if they were clear about the aims of the study and had any questions. At this point, any questions were answered before proceeding with the telephone survey. Each RA

1. Key contact verification • Initial telephone call with

nursing/training and

development/management to identify key contact

2. Key contact invitation

• Initial telephone call to introduce to study

• Confirm correct person

• Confirm willingness to participate

3. Interview set up

• Arrange appointment for completion • Send information sheet if appropriate

4. Telephone questionnaire completion

• Confirm consent • Answer any questions • Complete questionnaire

5. Update survey response master file

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formally introduced him/herself, the research study and the purpose of the telephone survey, including information relating to response confidentiality and anonymity as outlined at the start of the Telephone Survey Interview Log (see Appendix 4). The RA explained to the participant that the interview would take no longer than 15 minutes. The RA recorded all items as required on the Telephone Survey Interview Log, including interview disruptions and recommencement. The RA conducted the telephone interview in a secure room, which was quiet and where they could not be disturbed.

As long as the participant was willing to continue, the RA began with the interview by ascertaining verbal consent for the interview from the participant and confirming that all responses would be strictly confidential and anonymous. The RA explained that they would guide the participant through the interview and that if there was anything that the participant would like to say which was not covered there would be an opportunity to share this at the end of the interview. Each RA was familiar with the Telephone Survey Questionnaire in order to direct the flow of conversation with the participant and elucidate the essential data

required from the activity. During the interview the RA completed the Telephone Survey Interview Log as appropriate and noted down all relevant details. At the end of the interview the RA asked if there was anything else in relation to the Care Certificate and training which had not already been covered and that the participant wishes to mention. The RA would record any other comments which the participant wanted to be recorded. The interview finished with the RA thanking the participant for their time and telling the participant that this marked the end of the interview. The RA asked the participant if they had any final

questions before completing the call. The RA informed the participant that they were free to contact them if the participant thought of anything else he/she wanted to be recorded with their responses.

5.2

Analysis