One of the most stressful times for social care providers are CQC inspections.
Many have described inspectors as having an ‘agenda’ – looking to uncover negative evidence in order to substantiate preconceived determinations about the overall quality of the service and care provided.
This not only puts providers and staff under extreme pressure, but can also negatively impact the experience of the service users because time and resources which would normally be devoted to their care and treatment are re-allocated to address inspector concerns and questions.
In recent months the CQC has announced that it will be taking a new approach to inspections and in the last month it has even announced how it will be changing inspection focus in the short term to help address the bed shortage which the health and social care sector is experiencing.
This leads providers to question how they should handle inspections in order to get the best and most accurate reports published.
In this article I will discuss the changes which are being made to the CQC inspection regime and how providers can use the short-term focus change to their advantage so that they can potentially uplift their ratings and move forward in a cooperative manner with the CQC.
CQC Inspection Regime
In a previous article my colleague outlined important changes that the CQC was making to its inspection methodology and the timeline in which they plan to implement it.
Further, CQC has provided some guidance on its new ‘Single Assessment Framework’. The main change that the CQC will be making is replacing its existing key lines of enquiry (KLOEs) and prompts with new ‘quality statements’. Effectively, all providers, no matter their service type, will be assessed under the same standards, which will link to the relevant regulations to make it easier for providers, according to CQC.
The CQC has also developed six categories of evidence to provide more structure and consistency to their judgments:
- Peoples experiences;
- Feedback from staff and leaders;
- Observation of care;
- Feedback from partners;
- Processes; and
- Outcomes of care.
The CQC has also said that it wants to be transparent with providers and the public about how the information collected is used. Therefore, with each quality statement the CQC will state which evidence category is required and this will vary depending on the type of service.
In total there will be 34 topic areas across the five key questions, which will remain in place.
While the simplicity may be welcomed, it is unclear if this will be effective, especially given past concerns over the CQC inspecting providers under the wrong KLOE’s.
It seems that the evidence base will remain the same and the general structure (i.e. inspecting five domains) will stay the same, but which evidence the CQC chooses to focus on will be streamlined and selected depending on the type of service.
Trends Observed at Ridouts
At Ridouts we have seen a tendency for CQC to exacerbate the negative findings and discount any positive findings, particularly where these conflict with the negative findings.
In particular the following trends are prevalent in draft inspection reports that we review:
- Frontloading the negative comments so they are the first thing that readers are informed about, even when this doesn’t follow the question order in the KLOEs;
- Detailed comments for negative findings while sweeping, concise generalisations are noted for positive findings;
- Reliance on exclusively negative evidence (i.e. not considering all documents/feedback which are relevant to a concern);
- Incorrect application of inspection standards for the service type being inspected;
- Apparent agendas; and
- Failure to consider positive evidence, particularly where that conflicts with the alleged negative findings or concerns of CQC inspectors.
It seems that the above new framework may actually be more prone to the selective use of negatively biased evidence. However, much will depend on the inspectors’ attitudes and behaviour when they come to inspect a service and whether or not all relevant evidence is considered.
CQC Short-Term Approach
The CQC may be more open to change its ways in light of the current challenges that the sector is facing.
I recently wrote on the CQC’s announcement that it will, “Increase the number of inspections of care homes and homecare agencies with a current rating of requires improvement. Inspections will be carried out where there is information to suggest there has been improvement since [the CQC’s] last inspection.”
This means providers can start using this selective consideration of evidence to their benefit.
Action for Providers
Providers will want to start submitting all the evidence of positive improvement made in their homes – this may prompt CQC re-inspection with an intention to upgrade the rating and open up beds.
Further, they should also regularly review systems and processes as if CQC is coming in to inspect. This is because Providers should ensure that the day-to-day running will demonstrate without a doubt that the service should be rated as at least ‘Good’.
Finally, Providers should be privy to CQC guidance on how it inspects your service. These publications are meant to be the blueprint for Providers and is also a means by which to hold CQC to account on how it is supposed to conduct itself during inspections.
Conclusion
Overall, it seems the key focus for the CQC will be on practice and learning, especially in light of the announcement to re-inspect where there is evidence of positive change in a service.
The CQC really likes to emphasise where providers have, or have not, learned from prior shortfalls, no matter how minor. This is where the evidence categories come into play and we see many complaints from providers about over-reliance on minor, negative findings versus balancing that against the vast amount of positive evidence to counter these alleged concerns.
If there are robust systems in place and learning takes place and results in the embedding of improved practice the CQC will be hard pressed to find fault. Even if they do, a provider’s grounds for challenge to this decision will be that much stronger.
It is always important to ensure that anything being published about the service is factually accurate, so providers will also want to use the factual accuracy comments whenever they are issued with an inspection report that they disagree with, no matter how minor the disagreement.
If you require assistance or advice in relation to challenging CQC draft inspection reports or challenging other CQC enforcement action, our specialist solicitors can help. Please contact Ridouts Professional Services Ltd at info@ridout-law.com or by calling 0207 317 0340.
