- An unannounced CQC inspection can happen at any time and care providers need to be prepared for this.
- Care managers need to be familiar with the key lines of enquiry and their prompt questions, which are used by inspectors to check compliance.
- It is advisable for care providers to commission an independent mock CQC inspection to give them an opportunity to identify and address areas of weakness before they are rated by the CQC.
- A service that has already identified its weaknesses and is shown to be addressing them is more likely to be rated ‘good’ in the ‘well-led’ key question, leading to a ‘good’ rating overall.
- Care providers cannot afford to be complacent and need to be constantly reviewing and improving their service in order to gain the best rating.
There is almost nothing more important for the manager of a care service than the anticipation and experience of a CQC inspection, and the results from it.
We have come a long way in the last 20 years. Inspection used to be a private process between regulator and provider. Sometimes this led to enforcement. More usually, the result of an inspection gave the service provider an opportunity to consider an external objective review and make changes to improve. There was no challenge to the inspection report as such, because the reports were not public and, indeed, regarded as confidential.
Now all that has changed. CQC inspection not only vies for public media attention but reacts to stories in the media. CQC perceives its role to be a principal in the care process rather than a silent and objective reviewer. Not only is enforcement a more likely result of an adverse report, but also, following the introduction of service ratings, other impartial parties – the service users, relatives, investors, financiers of private and public services, purchasers and the wider public – are informed not only by the report but also by the media reaction.
Investment may be withdrawn, finance loans may be called in, and reputational damage may lead to cessation of referrals and even people being removed to an alternative service.
The published inspection report may seriously damage the business when subject to adverse reporting in the media. It can have more serious consequences than the process of enforcement, which, although time-consuming, always provides an opportunity for improvement. Other stakeholders may not be as generous.
It is therefore crucial that registered managers understand the process of inspection, and the principles and issues that lie behind the process, if they are to protect that business and their own job security.
Care service regulators have more statutory powers than any other regulators. They can enter, observe, enquire, demand explanations and form judgments at any time with or without warning.
Published policy may indicate anticipatable gaps between inspections, based on inspection findings. However, the reality is that inspectors may arrive at any time of the day or night without warning AND they must be admitted, welcomed and supported.
The right conclusion for the good manager is that they should expect inspectors at any time. The service should be held in a state of constant readiness. Good managers will know the format and obligations of inspection. They can and should obtain copies of both provider and inspector handbooks published by the regulator. All services should be constantly monitored against performance in the key lines of enquiry (KLOEs) and their published prompt questions used by inspectors to assess compliance.
In care services, CQC has deliberately chosen to avoid a rating which is equivalent to complete compliance. A service that is performing well but cannot yet be said to be constantly good so as to justify a sustained rating of good is, instead, rated requires improvement. The public, the media and external stakeholders, to whom I referred earlier, will perceive such a service as failing. They simply will not take the trouble to read into the CQC’s real meaning of ‘requires improvement’. CQC itself is now warning that it will try to carry out enforcement action against requires improvement rated services. Whether or not such action could be sustained in the face of objective external review is not the point. Such action will be interpreted as justifying enforcement, and may become a self-fulfilling prophecy of failure.
Managers should regularly seek out independent service experts who will carry out mock CQC inspections and thus enable managers to take action before it is too late. If legal enforcement is contemplated, such reports may be protected from disclosure, if they are commissioned through lawyers. In this situation, concerns may be written down or advised verbally to the care provider. What matters is that the prudent manager is ahead of the game to address objectively observed concerns.
Such actions will make it more difficult for the CQC to produce an adverse inspection report and rating. It may well be that a service that has identified its own shortcomings may be rated ‘good’ in the all-important domain of the ‘well-led’ category, despite being less than ‘good’ in the other key areas. A service that is well-led, self-reflects and addresses issues is more likely to be seen in a good light by a CQC inspector. If CQC has confidence in leadership, individual failings may not be viewed so seriously.
Managers should be constantly alert, and never rest on their laurels or be complacent, as the situation can so easily change. That is good care service management in 2018.
Preparation for inspection
You may or may not get a warning of inspection. If you do not, you will have no cause for complaint as this is within CQC’s rights. Hopefully you will have taken on board that ever-present rich opportunity of inspection.
If you do have warning, you are likely to receive a provider information return (PIR). This preparation has been well addressed in articles in Expert Care Manager Magazine (please see ‘Further information’). You can refresh your preparation from these articles.
You need to take the PIR seriously. Answer questions completely and honestly. If you hear of a weakness, identify that weakness and address it. CQC’s criticism will be restrained if they know you are tackling your weaknesses.
Above all prepare your staff. Train them to do themselves justice when speaking with inspectors. They must show how good they are. They, the staff, are your best service reference. Make sure you know if staff have concerns. Encourage staff to be your showcase to inspectors. You can find a reference to more information on how to prepare staff for inspection in ‘Further information’.
Let service users who have capacity and their families and friends know that an inspection is likely and may take place when they are visiting and tell them what to expect. Encourage them to share their experience of your service with the inspectors even if the inspectors do not specifically ask.
Do your very best to ensure that the service you manage is, justifiably, proud of what it provides for its customers. Encourage everyone to be at the front of sharing that pride with others and, in particular, the inspectors.
Above all, keep a record (in detail) of the preparations you have made. These may be vital at a later stage, particularly if you are concerned that the draft report does not fairly represent your service or even the way in which the inspection was conducted.
Be as ready as you can be!
In the next part of the article, I will be discussing the inspection day and what to do after the inspection.
- ‘Using the provider information return’, Expert Care Manager Magazine: https://tinyurl.com/ECMPIR
- ‘Using the provider information return’, Expert Care Manager Magazine: https://tinyurl.com/ECMUsingPIR
- ‘Preparing staff for an inspection’, Expert Care Manager Magazine: https://tinyurl.com/ECMStaffPrep
About the author
Paul Ridout, Managing Director, Ridouts Professional Services PLC has worked with providers of health and social care services for more than 45 years. He heads a team of expert and experienced lawyers in health and social care regulation and operation. The team of 10 has over 100 years’ combined experience. Ridouts delivers advice and support for care service providers on registration, inspection, CQC enforcement, safeguarding and related contract, employment and operational issues. These include challenging inspection reports and arranging mock inspections for care providers, working with Ridouts’ consultancy team. www.ridout-law.com