The way in which CQC inspectors are meant to conduct inspections (from preparing the visit down to publication of the report and reviewing action plans from providers) is set out in an internal CQC guide called the “Inspector’s Handbook Compliance Inspections” which went operational in July 2012. We have obtained a copy under a Freedom of Information request and it makes for interesting reading. Some of the more significant issues are commented on below.
The expertise of inspectors
The Handbook states that, “Our inspectors will have an in-depth knowledge of the services we regulate. They will have designated portfolios, which will be kept under review to support this”. Given this commitment, it would be perfectly reasonable to enquire what professional expertise your compliance inspector has to be able to inspect your service. As they are judging your competence to run the service, it is reasonable for them to demonstrate their competence to inspect you.
The Handbook sets out a number of pointers for inspectors in planning for a scheduled inspection. One is that, “Focus starts on regulation(s) you may not have inspected before (at least five), concern(s) or gaps in information”. One will be from each of the chapter headings from the Guidance about Compliance (except the chapter “Suitability of management”). These are:
- Involvement and information
- Personalised care, treatment and support
- Safeguarding and safety
- Suitability of staffing
- Quality and management
However, Outcome 4 (Regulation 9) – care and welfare of people who use services – will always be inspected. In addition, if multiple instances of potential non-compliance are identified early in the inspection, the inspector will be expected to assess Outcome 16 (Regulation 10) – assessing and monitoring the quality of service provision.
Where there is more than one regulated activity provided at a location, the inspector must decide which ones will be part of the inspection. For many care homes with nursing, for example, there will be the regulated activities of treatment, disorder and injury and diagnostic and screening procedures, as well as the normal accommodation for persons who require nursing or personal care. The lead inspector should tell you at the beginning of the inspection what Outcomes will be reviewed as well as the regulated activities that will be covered. At the end of the inspection, when receiving feedback from the inspector you can ask what issues were considered under each regulated activity considered, particularly if non-compliance is raised. This is because there is a risk that the inspector will set compliance actions for all the regulated activities when there is no justification for doing so. We have challenged CQC on setting a compliance action across, say, three regulated activities when normally one would expect it to fit into only one, typically in a care home context, persons who require nursing or personal care. This is a welcomed clarification.
Guidance about compliance
You should not feel pressurised into following a particular approach preferred by an inspector. We come across cases where the inspector will try to insist on something being done in a particular way. We all have our whims, and inspectors are no different. If what is being asked for is not specifically required by the Regulations (which almost certainly is going to be the case given their general nature) you have scope to do things your way. That also applies to the Guidance about compliance. As the Handbook confirms, although the Guidance about compliance is there to help providers comply with the Regulations, providers “…are not legally bound to use them. If they decide to follow alternative arrangements they must be able to demonstrate to CQC that they have taken account of the outcomes and prompts when judging their compliance with the regulations in their day-to-day activities”.
The Handbook states that although the focus of the inspection is non-compliance, where providers are compliant with a Regulation, the inspector should give examples of what he or she saw and heard that confirmed this. Equally, if a provider is compliant and non-complaint with different parts of a Regulation, the inspector should report on both. We come across many reports where there is an evident lack of balance.
Feedback at the end of the inspection
The Handbook advises that the inspector should agree a suitable time to give feedback, adding that all the inspection team should be present for the feedback session. It should be an opportunity to discuss findings. You should feel able to challenge an inspector on their findings. It will be important for a note to be taken of the feedback. Almost certainly CQC will be taking a contemporaneous note of what has been discussed so you should as well.
When to expect publication of the report
The Handbook states that the target date for the provider to receive the draft report is 10 working days after the date of the last visit. You will then have 10 working days to submit factual accuracy comments. If none are submitted, the final report will be generated. If you do submit factual accuracy comments, the target is for these to be considered by CQC within 5 working days (or one calendar week) as the expectation is that the final report will be published 15 working days after the provider was sent the draft. Therefore, the publication of the final report should be within 25days (5 weeks) of the last visit. If there is a significant delay to this timetable you can challenge the publication of the inspection report. The Handbook anticipates challenges stating that these “…would be on the basis that judgements were no longer timely and therefore inaccurate and a misrepresentation of the service provided”.
The Handbook notes that if compliance actions have been set, the provider will have 7, 14 or 28 days from the date of the final inspection report was published to submit an action plan (depending on the time limit included in the report). We would recommend that an action plan is submitted as soon as possible after receipt of the draft report for those issues that are not the subject of challenge.
What happens if you do not submit an action plan within the time frame envisaged by the report? You will be given an extra 7 days. If you still fail to submit one, a management review will be organised, which may lead to regulatory action being escalated such as a follow-up inspection or service of a warning notice. The same will apply to an action plan that is judged to be not suitable. You will be given 7 days to submit a new one. If you don’t, or the second one is still not suitable, then the matter will escalate to a management review.
Getting hold of the Handbook
If you are interested in obtaining a copy of the Handbook email us on Samantha@ejq.bb1.myftpupload.com. Please bear in mind that the copy we obtained was the version that went live in July 2012 and may be subject to periodic review and amendment.
If you are encountering regulatory difficulties we would urge that you take early legal advice. Please feel free to call us with any queries you may have about CQC’s regulation of your services.