Could Improvements post-inspection now be reported on in CQC reports? (as published in Healthcare Business – September 2018)

Topics covered: Caroline Barker, challenging inspection reports, CQC, CQC inspection, Healthcare Business

CQC inspections have, for years, been considered a “snap-shot” of a home/location on the day of the inspection.  CQC rock up, take a view of what they find, and then write a report and make a judgment on an appropriate rating.

When challenging inspection report findings and ratings, sometimes our clients will provide us with evidence to demonstrate that corrective action has been taken and we have to tell them that this will have no impact on the factual accuracy process, as it occurred after the inspection.  Such matters are different for Warning Notices or Notices of Proposal where improvements can have an impact on representations and enforcement action taken.

However, it would appear that CQC may have shifted its position following (or at least speeded up by) the Independent Report to the Board of CQC on CQC’s Regulation of 14 Colne Road Care Home (“Care Home”).  The Independent Report was instigated following a headline appearing in a newspaper in July 2017 alleging that CQC covered up a suspected rape in the Care Home.

One concern that arose in respect of that matter was the lack of clarity about the state of services at the time of publication of an inspection report.  In that case an inspection was carried out in November 2015 and the report arising out of that inspection was published in January 2016. Between these two dates, it came to CQC’s attention that the deputy manager of the Care Home was an illegal immigrant on the sex offenders register and that senior managers of the registered provider had instructed staff not to report the alleged rape to the police. In addition, a further inspection was carried out a week before the November 2015 report was published and this inspection rated the Care Home as Inadequate.

Of course, none of these issues were noted in the published November 2015 report – they occurred after the inspection.

According to the Independent Report, CQC has changed its guidance so that “reports should be “videos not snapshots” of the day of inspection”.   I submitted a Freedom of Information Request to CQC asking for a copy of this guidance.  CQC recently responded and referred me to the May 2018 “How CQC monitors, inspects and regulates adult social care services” Guidance (“Guidance”).  The Guidance clearly notes that “The site visit is one element of the inspection, and information may be received after the site visit which we may report on”.  CQC will draw evidence from four sources of information; 1) pre-inspection planning and evidence gathering; and 2) evidence from the inspection visit – all very straight forward, however it will also draw evidence from 3) ongoing local feedback and concerns and 4) its ongoing relationship with the provider.

The Guidance does not make any reference to inspectors ensuring that “their reports are detailed and up to date as near as possible to publication” as was claimed it did in the Independent Report.  Yes, reference is made in passing to information received/available post-inspection but it does not state how it will be considered or reported on within a report (note that it says it “may” be used) or how long after the inspection information will be considered.  However, a key concern arising from the Independent Report was ensuring that information as contemporaneous as possible was placed into the public domain so that the public could make an informed choice about their care.  In that case, the position of the Home had, according to CQC, deteriorated – but what about a service that has improved?  There may be an opportunity here for providers to supply information to CQC about improvements made to a service.

If the Independent Report recommendation that “Guidance to inspectors needs to be clear that inspection reports must accurately reflect the state of the service as close as possible to the time those reports are published” is to be adopted by CQC, then this truly opens up an opportunity on both sides to ensure a shift in position at the service, after inspection, is noted – for better or worse.

At the very least, it would provide more of a running commentary on the service but how that would affect a service’s Rating remains to be seen.  It was noted in the Independent Report that “It barely needs spelling out that the headline ratings are likely to be what potential service users look at first. Many, I suspect, will barely look beyond a “good” rating.” Whilst a service may be considered a particular rating on the day of inspection, it may not be considered wholly accurate to maintain that rating, at the date of publication, should something have changed following the site visit.

The Guidance does not really address the issues raised by the Independent Report.  I did question with CQC if they were sure they had sent me the correct guidance document and at the date of publication of Healthcare Business, their response is still awaited but should CQC wish to move to more contemporaneous reporting then they will not only have to resource this sufficiently (a huge task if they are to do this properly) but also be open to reporting on improvements and not just deteriorations.  CQC cannot have its cake and eat it.  It will have to report on improvements and success stories too. Perhaps this could be the start of something big.

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