Last month we spoke about the Compliance Review process and what you could expect during a visit from the Care Quality Commission (“CQC”). This month we discuss the resulting Compliance Review Report and how it should accurately reflect the findings on the day of inspection.
CQC are legally required to prepare a report on the matters inspected and send a copy of the report to the Provider and manager “without delay”. Sometimes CQC try and combine several inspections in one report and this should not be accepted where inspections happen days or weeks apart.
When a report is produced it is in draft form. CQC Guidance states that Provider’s have 10 working days to challenge any factual inaccuracies in the report. CQC have stated to Ridouts and our Clients that Provider’s are unable to challenge Judgements. This is irrational and fundamentally unfair. In any event, CQC Internal Guidance for inspectors on “How to complete and publish review of compliance reports” states that where the inspector identifies non-compliance (below the bar) but the Commission does not take enforcement action and the Provider does not agree with the Judgements, this should be managed as part of the factual accuracy process.
It is important that challenges to reports are made where the content is inaccurate or misleading. Inspections are publically available documents. Bad inspection reports can damage reputation and goodwill; Local Authority and privately funded residents may withdraw or not make further placements and poor inspection reports can lead to further enforcement action. If reports are not challenged it will be taken that the Provider accepts the content. Although CQC do not publish Provider comments on the web Providers can make their response available at the location to service users and families and send them to commissioners.
Not only is it important to challenge factual inaccuracies but also challenge:
- Negative wording or connotations – for example, Ridouts has seen a comment in a report which stated that a service user necklace had not been put on properly. It was unclear what point CQC were seeking to make but it suggests to the reader that that the necklace was compromising the service user’s safety. CQC should be asked what purpose the comment serves.
- Imprecise wording – for example, CQC may say “some care plans were not up to date”. CQC should clearly state how many care plans and what proportion of all care plans this relates to as 2 of 4 care plans not being up to date is very different to 2 of 50 not being up to date. Lack of precision can create an unfair and inaccurate picture.
- CQC should be pressed to clarify matters – for example, CQC may say “care plans did not contain all required information”. CQC should specify what this “required information” is to allow a Provider to comment on whether that information is required and whether the Provider is falling short of what the regulation requires.
- CQC acting beyond their powers – for example, Ridouts often sees CQC trying to make Guidance into legally binding Compliance Actions.
- The robustness of evidence presented. CQC Guidance “Setting the Bar: Monitoring of Compliance” states that “All decisions rely on robust evidence, local knowledge and professional judgment supported by our quality framework that ensures appropriate and proportionate decisions are made”. CQC should triangulate their evidence.
- The Judgments made – The evidence collated and which forms the text of the report is translated into Judgements for each Outcome. CQC will decide whether the Provider is Compliant or whether they have Minor, Moderate or Major concerns regarding non-compliance. These concerns are translated into points, and depending on the score may lead to enforcement action being taken. CQC should use the Judgement Framework to reach a sensible and balanced conclusion and where they do not, reference to the Judgment Framework should be made.
It is important to go through the report line by line and consider each phrase and comment. Although this may seem laborious – it is important that any valid objection you have is lodged because should matters progress further in the form of enforcement it will be much more difficult to challenge them at a later date and the validity of that challenge will be questioned when a contemporary challenge was not made. Only full robust comments backed up with evidence will have an impact on the draft report where the report is incorrect.
Often Providers think that if they produce an action plan and send it to CQC this will be enough to get CQC off their back but all that producing an action plan does is to admit that the Provider is in breach of the regulations. Of course do not challenge things for the sake of it – otherwise you will be seen as a trouble maker and you are less likely to be taken serious when you do have valid concerns. However, CQC should be challenged vigorously where the outcome is not accurate, not evidenced backed and their own guidance has not been followed.