Most businesses (with the exception of health service bodies) providing care regulated by the Care Quality Commission (“CQC”) are subject to a registered manager condition under regulation 5 of the Care Quality Commission (Registration) Regulations 2009 (“Registration Regulations”).
Each regulated activity is required to be managed by a registered manager, and the Health and Social Care Act 2008 (“the Act”) specifies that the registered manager must be assessed for their fitness to do so. The Act requires CQC to be satisfied that applicants are compliant and will continue to be compliant with the requirements. For individuals, partnerships and managers, one of the requirements is that the applicants must be ‘fit’.
The requirements for a registered manager are that they are:
- Of good character;
- Physically and mentally fit to carry on a regulated activity and have the necessary qualifications, skills and experience to do so; and
- Able to supply CQC with all the requirements as specified in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 (“Regulated Activities Regulations”).
The process adopted by CQC in determining whether a potential registered manager is fit to carry out their role includes a fit person interview. Following a Freedom of Information Request to CQC, we have obtained internal guidance from CQC outlining what types of questions a potential manager should expect to be asked during the fit person interview along with further information on the fit person process in general.
The registration handbook states “As part of establishing if an applicant is fit to be registered [CQC] will need to carry out a fit person interview. Fit person interviews are not just for new managers and providers but also for registered persons making changes to their registration.”
The handbook advises CQC staff that fit person interviews are a key part of the assessment process and may be the focus of a tribunal if CQC refuse an application. CQC’s notes from an interview may be subject to disclosure under a Freedom of Information Request. CQC staff are advised that they should not inform applicants of the outcome of the assessment at the end of an interview as they do not have the authority to make that decision. The assessor’s manager is responsible for deciding the outcome of an assessment.
Interviews in most circumstances should take no more than one hour. The purpose of the interview is to aid CQC in considering the ‘fitness’ of a new applicant (to carry out their role as a registered person) for registration under the Act.
The interview may contain questions related to the following elements:
- Application form details including medical or financial declarations and employment history.
- Duties and responsibilities of the manager.
- Criminal convictions.
- Academic and vocational qualifications and experience.
The applicant will be expected to be familiar with guidance about compliance and the underlying legislation (namely the Act, the Regulated Activities Regulations and the Registration Regulations).
The interview will usually start with CQC ensuring that there have been no changes to the application since it was submitted and confirming the service the applicant intends to provide. They will be looking for the applicant to be able to demonstrate their understanding of the relevant regulated activities applicable to the service.
Once CQC have established that the applicant is clear about the service provision, CQC are likely to ask the following:
- What are the basic principles and values you feel are essential when delivering or offering a service to people?
- What are your responsibilities as a registered manager to ensure you operate services within the law?
- Do you know who would be legally responsible for non-compliance with the law, and any offence committed under the Act?
- What changes and incidents affecting your service or the people who use it must you tell CQC about?
- How will you assess and monitor the quality of service provision, and how will you then use this information to make sure that you provide good outcomes for people who use the service?
- How do you make sure that the staff you recruit will be suitable and competent for their job role?
- How do you make sure that everyone who works in the organisation continues to be skilled and competent for their job role, including yourself?
- Can you give me some examples of what you will do to involve people who use the service in the day-to-day running of the service or in deciding on any changes?
- Can you give me some examples to show how you promote equality and diversity, and respect people’s human rights?
- How will you protect the people who use the service from potential abuse or neglect? If treating children, what specific arrangements are in place for safeguarding children?
- What would you do if someone reported to you that an incident of negligence or abuse had occurred?
- How will you make sure that people’s records are maintained and stored correctly?
- Is there anything else you would like to add that you think will help us to decide on your application?
Interviewers may also ask service-specific questions or frame questions around the content of the application form or DBS check if required.
The key responses CQC are looking for through their questioning include clarity and openness; an understanding of regulatory responsibilities; knowledge of groups of service users; systems for monitoring quality in place; and recognition of person-centred care needs of service users.
The fit person interview may be preceded or followed by a site visit. Site visits are used as a further way of gathering and assessing information or evidence about the applicant’s ability to comply with the regulations. CQC will inform the applicant if and when they intend to carry out a site visit. During the site visit CQC staff are able to request copies of documents, such as policies and procedures, that they may rely on while making their judgements. CQC staff are advised to ensure a comprehensive audit trail to demonstrate that they have carried out appropriate investigations prior to making a decision.
Assessment of good character
One aspect of ‘fitness’ requires a person to be of ‘good character’. CQC’s internal guidance for staff “fit person assessments” outlines what interviewers should look for in assessing good character. The attributes listed that could be associated with ‘good character’ include:
- Openness or transparency
- Ability to abide by the laws of the land
CQC staff are advised to consider the applicants position carefully if it appears that the applicant cannot demonstrate a track record of these qualities, or demonstrates a lack of them in their dealings with CQC during the registration assessment process or in their previous behaviour. CQC staff are told that if they find a potential cause for concern, they should discuss the concern with the applicant at interview and consider their responses in order to come to a view about their fitness.
Typical information CQC will look at to assist them during the assessment include:
- DBS checks.
- Declarations by the applicant on the application form.
- Prior employment history, including reasons for leaving previous positions.
- Any known intelligence about the applicant from their existing or previous registrations, although being careful to ensure any intelligence is relevant and reliable.
- Whether the applicant has ever had their registration cancelled by a regulatory body and, if so, the reasons.
- Whether the applicant is, or has ever been, the subject of any investigations or proceedings by a professional or regulatory body, including bodies in other countries.
- The extent to which the applicant is open and honest with the assessor about any of the above.
Assessment of qualifications, skills and experience will depend on the regulated activity and service type.
What happens next?
Following the interview and site visit CQC will review the evidence collected to determine the result of the recommendation to their manager on the outcome of the application.
It is clear that CQC are looking for applicants that understand their regulatory responsibilities. Applicants should prepare thoroughly for the fit person interview to ensure the greatest chance of success.