CQC have recently published a booklet aimed at helping providers understand how CQC check their services for compliance with the essential standards and how providers can make sure they are prepared for an inspection by CQC, as these are usually unannounced.
Below we summarise some of the main points covered in the booklet and outline the advice given in relation to considerations providers can take to ensure the home is compliant and inspectors are helped in their information gathering exercises.
The focus of the inspection
CQC state that the focus of their inspections is on the regulations and that they make their judgements against the regulations, and these judgements are informed by inspectors viewing the experiences that people have when they receive care. CQC will check their findings in a number of ways, including looking at records and speaking with staff.
In order to be prepared for an inspection providers should:
- Include clear information in notifications to CQC about each event and what actions were taken.
- Make service users aware of the ‘Please tell us your experience’ forms on providers profile pages on the CQC website, as this can help CQC understand how people experience providers services.
When CQC arrive
When CQC arrive they are required to tell providers which of the essential standards they will be inspecting. If they decide to check additional standards during their visit they should let the provider know. CQC will ask the provider to organise a suitable room or place for them to use for the duration of their visit. They may need to use the room to interview staff, people who use the service, their relatives, advocates or carers.
In relation to this providers may want to consider how they ensure that people who use their service and their staff understand what may happen during an inspection.
During the inspection
During the inspection, when CQC speak with managers and members of staff, they do not expect all members of staff to have the same knowledge, but they do expect them to understand their role in providing good outcomes for people and know what to do if they have concerns.
CQC explain that they may carry out pathway tracking which involves them following a person’s route through the service and getting their views on it. When CQC look at specific areas of a service they won’t be prescriptive in what they expect from, for example, support plans or medicine recording. However they will expect records to be sufficiently detailed and accurate to ensure people receive safe care and good outcomes.
In order to be ready for a CQC inspection of this nature, providers may want to consider:
- Making staff aware of the methods CQC use to gather evidence.
- Making it clear that CQC don’t expect all staff to have the same level of knowledge and understanding.
- How you will be ready to produce documentation during the visit. If there is a valid reason why you cannot locate documents during the visit CQC will usually allow providers 24 hours to produce them.
- Including a contents page at the front of each care plan so that inspectors and staff know what they can expect to find and where.
- Maintaining a folder that directs staff to where they can find information quickly e.g. health and safety training records.
CQC state that they will always check evidence of non-compliance with other evidence, unless the evidence is so strong that it can be used on its own.
The end of the inspection
To ensure that their judgements are robust, CQC may ask for additional information to confirm evidence they have gathered during the inspection. If CQC do ask you, it must be provided within 48 hours.
CQC should provide feedback at the end of the visit. However, there may be occasions where they do not do this, for example if a number of inspectors or experts are involved in the visit and they need to group their findings together to reach a judgement.
Providers should ensure that they are checking with the inspector before they leave that they have been provided with all the documents they have asked for, and spoken to everyone they needed to. Inspectors should always make sure they have sufficient evidence to reach their judgements, and they are expected to take a proportionate approach to reaching these judgements.
The inspection report
The draft inspection report will be sent by email. This will usually be within 10 working days of the date of CQC’s visit. Providers have 10 working days to check the report for factual accuracy and send CQC comments on a template that they will send out with the email. CQC will send providers a final copy of the report, usually within 15 working days of the date that they sent the draft report.
Reports will be published on the website within 10 working days of the factual accuracy check being finalised.
Actions CQC can take and how they follow up compliance and enforcement actions
CQC generally use compliance actions in response to breaches of the regulations with a minor impact on people, or where the impact is moderate but it has happened for the first time.
CQC will check upon compliance actions within 12 weeks of the date providers tell them they have become compliant. They may follow up with a visit, or they may be able to review the information providers send them and confirm this with a telephone call. If their judgement confirms that providers are now meeting the regulation, they will publish this judgement in a report and there will be a green tick on the provider’s page on the CQC website next to the appropriate standard.
Community based providers may be subject to different inspection methods from CQC
In relation to domiciliary care services, CQC may arrange to contact people who use the provider’s service to talk to them about their experiences, arrange to go out with staff where they are carrying out checks, or carry out home visits to speak to carers or people who use the service. CQC may ask providers to help them arrange this. With both Shared Lives schemes and domiciliary care services, CQC will visit the main office to check records and they may also ask for visits to be arranged to meet people and their carers at home. However, they will only do so if they are specifically invited to. CQC will otherwise gather the experience of people who use the service by arranging to meet them at a day service or other place outside the home.
This is helpful guidance to providers and managers with practical tips on preparing for an inspection and dealing with the inspection itself. The key is to take an active approach to the inspection, ensuring that any additional information is submitted to CQC within 48 hours of the visit. Another key issue covered in the booklet is responding to the draft report in terms of factual accuracy and the final report in terms of an action plan. Although CQC say that providers can only respond to factual issues that is wrong as a matter of law. Providers can and should respond to findings and judgments where those matters are capable of being challenged. It will also be important to submit action plans swiftly to CQC, followed up by evidence of compliance being achieved, assuming of course there were genuine deficits that needed to be addressed. The quicker you can demonstrate compliance, the sooner the provider profile can be amended by CQC to show a green tick for compliance. It will therefore be essential to diarise the necessary responses to CQC and ensure they are submitted and followed up.
At Ridouts we have considerable experience of advising providers on all aspects of the inspection process. We would be happy to talk through any issues with you about CQC’s regulation of your service.