In recent months Ridouts have seen an increase in irrational behaviour and errors in judgement by CQC staff. The recent and anxious recruitment drive by CQC to increase the numbers of inspectors may be responsible for the apparent decline in the quality of inspection reports and lack of informed approach to inspections. Notable misdemeanours include intimidating staff, the use of rude and dismissive language and refusal to look at vital documentation. A number of clients have observed this behaviour during an inspection but have been too intimidated to raise a concern at the time, fearing that doing so would encourage the inspector to give an unfavourable review of their service. It is only when providers receive their draft inspection report that they realise the full impact of the inspector’s conduct and how it could affect the way that their service is viewed by readers of the report.
Examples of cases reported to Ridouts include: an inspector who judged an Outcome to be “Requires Improvement” but failed to mention that they emphatically refused to look at records which proved that the provider was actually meeting the relevant standard; and an incident where an inspector inspected a service, asked the management team a number of personal questions about their marital status and discussed confidential information about another local service with staff.
Providers should not be afraid to challenge the conduct of an inspector that has clearly had an unfair impact on the draft inspection report or seems in any way inappropriate. It may be considered that this is best done during the factual accuracy process, when providers are asked to comment on anything in the draft report that they deem to be factually inaccurate. Many representatives of CQC have argued with Ridouts that such matters of conduct cannot be dealt with at this stage; however, Ridouts always argue that this cannot be right. If such conduct has led to an inspector’s misjudgement or false statements, then the report is inherently inaccurate. Factual accuracy and the judgement of an inspector are inextricably linked.
CQC’s own internal guidance for inspectors (“Inspection Handbook – Adult Social Care”) supports our view. Paragraph 3.2.6 states:
“Explain that ratings will be based on our evidence about the service, and should they have concerns about the ratings we award them, they will have the opportunity to question this during the factual accuracy process”.
Providers should therefore feel confident that their concerns should be taken into account at this stage in the review process.
It is important to point out at this stage that a provider may also consider making a complaint about an inspector as soon as the inspection has finished, rather than wait until the draft inspection report has arrived. This would prevent CQC from assuming that the complaint had only been raised because the provider was unhappy with the result of the inspection.
Such a concern can be made through a Stage 1 complaint to CQC. It is essential that inspectors be held fully accountable for their behaviour whether it impacts the draft inspection report or not. Providers should feel confident that the inspector will be transparent and fair. Staff at the services being inspected should never feel intimidated or bullied and should be free to demonstrate the quality that a service truly provides.
CQC inspectors should provide an impartial, balanced and proportionate view of a service on the day of the review. All of the information that they gather should be robust, reliable and corroborated.
To ensure that inspectors give a true and accurate picture of a service in their report we advise providers to assign a member of staff to shadow the inspector during the visit. This person should take a detailed note of what the inspector is reviewing and any comments that they make. It would also be sensible to record what documents the inspector has been offered and whether they reviewed those documents. If an inspector refuses to look at documents that a provider feels may be important then these should be sent to that inspector and their manager within 24 hours, explaining the reasons for doing so (i.e. that the inspector failed to take the information into account).
In the event that an inspector has been rude or intimidating to either staff or service users, a provider should consider taking a full statement from the individual concerned as it would be useful should a complaint be made and whilst the incident is fresh in the mind of the people involved. If at any stage during the inspection a provider feels that the conduct of an inspector is upsetting the service users or staff, it would be entirely reasonable to ask that inspector to leave on the basis that the provider owes a duty of care to those parties and that the inspector’s conduct is unacceptable.
It is vital to ensure that a service is being honestly and fairly reflected by the regulator, particularly since prospective service users and their families will be reviewing the finalised report on CQC’s website and it will be sent to commissioning parties to inform decisions about the sustainability of a commercial relationship. Ridouts would advise that if an inspector demonstrates unreasonable behaviour then a provider should take steps to make their concerns known to CQC, be it during the factual accuracy process or via a stand-alone complaint to the regulator.
CQC are keen for providers to adhere to the standards set by law, however, we should also be mindful that inspectors too have their own code of conduct which they should be careful to follow.