Quality & Compliance Magazine: Q & A

Topics covered: Ridouts professional advice

CQC have given me 5 days to complete Provider Compliance Assessment forms.  This is not long enough – what can I do?

The 5 days request is CQC internal guidance only, however, where such a timeframe can be adhered to then it should.  As explained by Neil Grant in last month’s Q & A, you are not obliged to use the CQC PCA format, albeit that it is preferable.  In any event, you should have all required information to hand as you are required to evidence compliance with the Essential Standards, so five days should be plenty of time to collate your evidence. However, what is important is that any information submitted to a PCA request is thorough and accurate as CQC will use this information as part of its assessment of your compliance.  If more time is required, then I suggest that CQC is informed sooner rather than later but every attempt should be made to comply with the timescale.

My local authority has written to me to say they are going to reduce my fees.  Do I have to accept this?

The simple answer to this is no.  One contract partner is simply not permitted to vary established contract terms without the consent of the other.  It is not open to the Local Authority to unilaterally reduce fees and to do so is a clear breach of contract.  However, you need to weigh matters up from a commercial aspect.  If you are not willing to reduce your fees, then the LA may either stop commissioning services from you or may try and remove service users from your home (the latter cannot be done without proper reference to contractual terms and service user choice of where they live).  Whether you are willing to accept this will depend on how reliant you are on the LA for business and how often they send you service users.  You may be willing to enter into negotiations or not.  Every case needs to be looked at on its merits and we would be happy to speak with you regarding your case, however, LAs should not deduct money unilaterally and this should be challenged robustly.

I have been criticised by CQC because an employee hasn’t used the home’s whistle blowing procedure and they are saying I’m in breach of Outcome 7, Safeguarding people from abuse.  Is this true?

The regulations requires the Provider to make suitable arrangements to ensure that residents are safeguarded again the risk of abuse by means of taking reasonable steps to identify the possibility of abuse and prevent it before it occurs; and responding appropriately to any allegations of abuse.  This is a two stage approach – 1) reasonable steps to identify and prevent; and 2) responding appropriately.  You state that you have a whistle blowing procedure in place.  This is good.  It is important that the procedure is made known to both staff and service users and their families.  Of course having a whistle blowing policy and procedure in place is not the only step that Provider’s can take to identify the possibility of abuse – Make sure your Recruitment procedures are robust and compliant with the Regulations; Look at complaints –are there any areas of concerns, are the same issues cropping up?; Look at Regulation 18 notifications and see if there are any patterns to the notifications raised;  Ensure staff are adequately trained to carry out care practices appropriately; that they understand what safeguarding is and how to recognise abuse and if restraint is carried on it is done appropriately and in the correct circumstances.  The fact that someone has chosen not to use a whistle blowing procedure that they are aware of does not indicate that a provider is in breach of regulations.

Do I need to worry about my CQC Quality and Risk Profile?

CQC has not issued adult social care providers with their Quality and Risk Profiles (other than Version 0 as part of the re-registration process last year) even though they are being used by the regulator in estimating the risk of regulated services failing to comply with essential standards.  CQC updates the QRPs on a monthly basis.

Internal CQC guidance to inspectors states that QRPs should not be disclosed to providers but that they will be made available in due course. It had been hoped that QRPs would be made available to providers this summer however the July CQC newsletter is silent about the date of disclosure stating, “We are continuing to develop QRPs for adult social care and independent healthcare providers. Our aim is to share QRPs with these providers in the same way as we do for the NHS, once this development work is complete”.  The best guess at the moment is that adult social care providers may see them in the autumn.

There will be a QRP for each location, providing an estimate of risk for each of the 16 key outcomes. The intention on the part of CQC is to share these QRPs with commissioners, as well as providers, so it is essential that they portray a fair picture of the particular service.  It will be important for providers to familiarise themselves with the way in which the risk estimates are calculated, based on statistical measurements of actual performance against expected performance.  However, it should be noted that the risk estimates are not judgements which can only be made by the inspector as part of a compliance review.  If a provider believes a risk estimate to be unrepresentative of the service it will be important to challenge it as commissioners may view the provision negatively even though no definitive judgement has been arrived at.

If you would like a copy of the internal CQC guidance for inspectors on how to use QRPs in relation to adult social care providers (which Ridouts has obtained under Freedom of Information Act), please contact us at info@ejq.bb1.myftpupload.com.

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