Getting Rid Of A Poor CQC Rating

Providers often find it difficult to shake off a poor CQC rating. Once the CQC has downgraded a service’s rating it often takes more than one inspection for the rating to be upgraded. In this article I explore the difficulties providers face to get the CQC to re-inspect and re-rate their service, in light of the CQC’s change in agenda this winter to increase capacity in the sector.

The Impact Of A Poor Or Inaccurate Rating

In accordance with its guidance ‘How CQC monitors, inspects and regulates ASC Services’, the CQC should approach each inspection “by looking for good practice”. However, providers repeatedly find that the CQC inspect in response to whistleblowing concerns and the inspection becomes a process of the CQC collecting evidence to support allegations or concerns. Such an approach taints the inspection and leads to disproportionate judgements.

The factual accuracy process does not result in the publication of a factually accurate inspection report when provider’s challenges can be senselessly rejected by the CQC. The rating review process, is limited in scope, and not an extension of the factual accuracy process or a second bite at the cherry and due to limited success, providers are left with seeking legal recourse through costly Judicial Review proceedings.

Does The CQC Recognise The Impact Of A Poor And Inaccurate Rating?

Providers can request an inspection at any time. It is a good idea to make a request when the rating is not reflective of the service either because it was inaccurate when applied or the service has since improved. Poor ratings can:

• have a negative commercial and reputational impact;
• impact the provider’s relationships with the community, commissioning bodies and families;
• impact on recruiting staff and marketing to prospective residents.

Whilst the CQC acknowledges in its State of Care Report 2021/22, the difficulties providers face in the sector such as recruitment issues. The CQC are not sympathetic to the cycle that providers are in when stuck with a poor rating. The results of a poor rating, such as recruitment issue can hold providers back from improving.

Does The CQC Recognise Improvement?

Regarding the current crisis in the NHS, the CQC announced that it would adjust its regulatory activity up until the end of this month, which would include inspecting providers with a Requires Improvement or Inadequate rating where evidence shows there has been improvement, with the aim of creating more capacity for discharge to adult social care by increasing the number of providers with a Good or Outstanding rating. This is not the first time the CQC has published adjustments to its regulatory approach. Back in October 2022, in an Executive Board meeting the CQC declared that an operational priority of the CQC in adult social care was “inspecting to increase capacity and recognizing improvement”.

These statements are high level, resulting in the CQC not being strict in observing its announcement. Due to the high number of services with poor ratings the CQC’s default is for inspection teams to plan inspections of the services in their portfolios based on risk, abandoning inspections focused on acknowledging improvements. Providers find that the positive statistics which illustrate an improved service are used by the CQC to deny that a poor rating is having a negative impact. This includes evidence of a service maintaining its number of residents, the local authority not placing an embargo or the service not needing support from the local authority.

According to its 2021 strategy, the CQC is aiming to move to “more dynamic and flexible regulation that provides up to date and high quality information and ratings….” This has not been seen to date. What we are seeing is that the current approach to regulation/inspection is leading to an increase in the number of services being rated as Inadequate or Requires Improvement. Timetabled inspections provided the service and the public with certainty. One hopes that the CQC’s new regulatory system/single assessment framework expected at the end of this year, makes a difference.