- ‘Is the service caring?’ is one of the five key questions that inspectors must answer when they look at a service.
- By 'caring' the CQC means that staff involve and treat people with compassion, kindness, dignity and respect.
- To prepare for inspections, service providers need to work through the KLOEs and ratings characteristics that relate to caring, ensuring that they are reflected in the policies and processes, audits and service plans.
- The KLOEs and ratings characteristics set out in the CQC guidance prompt inspectors to ask if people are treated with compassion, kindness, dignity and respect.
- Caring providers should be familiar with the descriptions for what CQC consider to be a ‘good’ or ‘outstanding’ care service (where applicable) for the key question ‘Is the service caring?’.
What does the CQC mean by 'caring'?
‘Is the service caring?’ is the third of the CQC’s five key questions that inspectors will seek to answer during the inspection process. By 'caring' the CQC means that staff involve and treat people with compassion, kindness, dignity and respect.
How will inspectors answer the question?
Guidance published by the CQC contains key lines of enquiry (KLOEs). These consist of a series of questions that inspectors are prompted to ask during inspections in order to inform their judgements and support the five key question test.
A full list of the KLOEs relating to caring is included below. The KLOEs used are those that were updated by the CQC in their 2017 Key lines of enquiry, prompts and ratings characteristics for adult social care services guidance. The guidance applies to adult social care inspections from November 2017 for both care homes and domiciliary care.
To prepare for inspections, and improve their ratings, service providers need to examine their services and work through the KLOEs and ratings characteristics that relate to them, ensuring that they are reflected in the policies and processes, audits and service plans.
What are the KLOEs for caring?
According to the 2017 guidance, the KLOE questions related to the caring nature of a residential or domiciliary service that inspectors will seek answers to during a site visit will consist of:
- C1 How does the service ensure that people are treated with kindness, respect and compassion, and that they are given emotional support when needed?
- C2 How does the service support people to express their views and be actively involved in making decisions about their care, support and treatment as far as possible?
- C3 How are people's privacy, dignity and independence respected and promoted?
Prompts and evidence
The main KLOE questions are supported by a further series of questions and prompts intended to help inspectors explore each aspect of a service. To see the questions that inspectors are prompted to ask for C1, C2 and C3, see the audit checklist in the toolkit.
Overall ratings characteristics for key question 3
Updated ratings characteristics are also set out in the 2017 CQC guidance. These provide inspectors with a picture or snapshot of what a service might look like if given a certain rating for a certain area of care.
In the overall rating characteristics for key question 3 inspectors are advised to look for the following:
In services rated as ‘outstanding’ for caring:
- People are truly respected and valued as individuals and are empowered as partners in their care by an exceptional and distinctive service.
In services rated as ‘good’ for caring:
- People are supported and treated with dignity and respect, and are involved as partners in their care.
In services that ‘require improvement’ for caring:
- There are times when people do not feel well-supported or cared for, or their dignity is not maintained
- The service is not always caring
- Regulations may or may not be met.
In services rated as ‘inadequate’ for caring:
- People are not treated with compassion
- There are breaches of dignity and significant shortfalls in the caring attitude of staff
- Normally some regulations are not met.
Which fundamental standards apply?
A number of the fundamental standards apply to the caring nature of a service. The standards, which are included in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, provide the legal framework with which inspectors can judge if a service is compliant with the law. Non-compliance will be subject to the CQC enforcement framework.
The regulations that have particular relevance to care and compassion include:
- Regulation 5: Fit and proper person: directors
- Regulation 9: Person-centred care
- Regulation 10: Dignity and respect
- Regulation 11: Need for consent
- Regulation 14: Meeting nutritional and hydration needs
- Regulation 16: Receiving and acting on complaints
- Regulation 17: Good governance
- Regulation 18: Staffing
- Regulation 19: Fit and proper persons employed
- Regulation 20: Duty of candour.
Care and compassion at the heart of services
Much has been written and said in recent years about the ‘caring’ nature of modern health and adult social care services and about a perceived lack of compassion, kindness and empathy on the part of health and care staff.
Addressing this issue has been a key driver in the development of the fundamental standards of care, the Care Quality Commission (CQC) inspection regime, and new training standards for staff. Indeed, the need for registered services to be caring and compassionate is seen by many in the adult social care sector as the most important element in the new CQC framework and guidance.
‘Is the service caring?’ is one of the five key questions that inspectors must answer when they look at a service. Many see the quality of caring as being the most important feature of modern services. The government introduced other measures to ensure health and social care organisations make compassion and care key elements in their delivery of services.
For instance, Part 2 of the Care Act 2014 takes forward the government’s commitment to improve care and ensure service users and patients are treated with more compassion and respect in all settings.
In parallel with the introduction of the Care Act, the fundamental standards place great emphasis on ‘caring’ and compassion.
Guidance notes accompanying ‘Regulation 19: Fit and proper persons employed’ of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 include a reference to providers ensuring that directors and staff demonstrate a ‘caring and compassionate nature’ appropriate to their roles.
KLOEs and rating characteristics for care and compassion
For both residential and community adult social care services, the KLOEs and ratings characteristics set out in the CQC guidance prompt inspectors to ask if people are treated with compassion, kindness, dignity and respect.
In the rating characteristics, the guidance states that in a residential or domiciliary service rated as ‘good’ for kindness and compassion (C1):
- The service ensures that people are always treated with kindness.
- This is reflected in the feedback from people who use the service, their families, friends and other carers, both to the service itself and to other people who have contact with the service - people are consistently positive about the caring attitude of the staff.
- People are treated with dignity, respect and kindness during all interactions with staff - their relationships with staff are positive. People feel supported and say that staff really care about them.
- Staff have the right skills to make sure that people receive compassionate support and have enough time to get to know them, including having enough time to enable them to understand people’s care and support needs, wishes, choices and any associated risks.
- Staff use accessible means of communication whenever needed.
- The service ensures that staff consistently treat people as individuals and quickly respond to changing needs.
- People know how to seek help and feel listened to.
‘Outstanding’ services are recognised in the CQC guidance where the service ensures that staff in all roles are highly motivated and offer care and support that is exceptionally compassionate and kind, caring for individuals and each other in a way that exceeds expectations. Staff are described as demonstrating a real empathy for the people they care for and all staff are particularly sensitive to times when people need caring and compassionate support. They discuss this with them and help people explore their needs and preferences in relation to personal and family support.
Services that ‘require improvement’ are described as ones where people who use the service and other stakeholders may have concerns about the way some staff treat people. People are not always treated with dignity, kindness or respect and staff do not always remember people’s preferences, or have enough time to find out what they are. Staff can be more focused on tasks than people and their wellbeing. Support can be inconsistent and not always respectful.
In an ‘inadequate’ service the CQC advise inspectors to look for characteristics such as a widespread and serious feeling amongst service users and their families that people are not treated with dignity and respect, and that staff can be unkind and lack compassion. Staff do not know about people’s personal histories and preferences. Discomfort and distress are common but not responded to.
Use the following item in the Toolkit to put the ideas in the article into practice:
About the author
Martin Hodgson RMN, BSc, MSc, PGCEA, is a community psychiatric nurse and a psychology graduate by background, Martin has had a long career working as a senior manager in various health agencies, initially to do with mental health and latterly to do with primary and community care.