- Familiarise yourself with the CQC’s key lines of enquiry (KLOEs) and understand what makes your service safe, caring, responsive, effective and well-led.
- All the evidence should be accessible to an inspector, including policies, procedures, feedback, complaints, notifications, care records, training records and staff records.
- CQC inspectors will ask you to complete the provider information return (PIR), where you can demonstrate your current values and practice and share forward-planning to develop and improve your service.
- It is important to include case studies as part of your evidence so that you can show practice rather than just theory.
It can be daunting for care providers to think that a Care Quality Commission (CQC) inspector could be on their doorstep at very short notice – usually in as little as 48 hours.
The best way to prepare for any inspection is to start today. Do not wait for that phone call to start getting ready for a CQC visit.
This way, as regular auditing and best practice becomes a part of your daily routine and practice, you will find that your anxiety levels fall when you are due for an inspection.
Key lines of enquiry
Familiarise yourself with the CQC’s KLOEs and understand what makes your service safe, caring, responsive, effective and well-led.
In November 2017, the CQC released updated KLOEs and ‘prompts’ (the questions that feed into the KLOEs). CQC inspectors use these questions to assess your service. For each question the CQC has set out what ‘outstanding’, ‘good’, ‘requires improvement’ and ‘inadequate’ look like, in the form of characteristics. CQC will then use this information to rate your service. It is vital that you and your team are familiar with the KLOEs and characteristics, so that you can all have a good understanding of what makes the service safe, caring, responsive, effective and well-led.
Evidence, evidence, evidence
Evidence is key! A good rule of thumb to adopt is: ‘if it is not recorded it has not happened’. Having all the information ready for an inspector will show that you are ready for anything. Policies, procedures, feedback, complaints, notifications, care records, training records and staff records should be easily accessible for an inspector. Feel-good stories and emails/feedback from families go a long way towards showing that your organisation is providing a high standard of care too. Surveys are important for interacting with family members, so keep lines of communication open and get evidence of the quality of your care. Be sure to analyse surveys to identify areas of improvement and good practice. Preparing for inspections in domiciliary care demands numerous records of your services, so make sure that these are clearly defined and outlined for an inspector to read.
Usually, before you are inspected, CQC will already have requested information from you in the form of a provider information return, otherwise known as a PIR. The documentation asks you to evidence how you are currently meeting the five KLOEs and what improvements you are planning in the future. This is a fantastic opportunity for you to introduce the inspector to your service, demonstrate your current values and practice, and share forward-planning in order to develop and improve your service in the future. At this point, remember to include examples and case studies to evidence practice rather than theory. Do your homework and review your PIR – it is likely that, during your inspection, questions will be asked in relation to this documentation. The CQC states in its Adult Social Care Handbook‘…if we have requested a PIR but do not receive the information, we will not normally award better than ‘requires improvement’ for the well-led question. This is because a good provider should have the information readily available through their own internal monitoring and quality assurance information.’
Bluebird Care in Winchester, Eastleigh and Romsey were inspected in September 2017 and received an ‘outstanding’ rating in all five categories. The CQC said in the inspection report: ‘We received some outstanding feedback about the provider. Without exception, people, their relatives and healthcare professionals told us they were extremely happy with the care and support provided by Bluebird Care (Winchester, Eastleigh and Romsey). People were placed at the heart of the service. The management of the service were dedicated in creating, nurturing and championing a culture within the service that was professional, compassionate and innovative. The registered manager and managing director were prominent role models. They took a leading role in demonstrating the values and standards they expected staff to embody by focusing on continuous improvement leading to positive outcomes for people.”
A solid, happy team that is prepared
A large part of impressing your inspector will be thoroughly prepared staff. Explain to your team what the CQC is, why the inspection is important and what sort of questions they may get asked. Practise questioning staff before the inspection – this will help them feel more confident on the day.
The most important part of preparing for an inspection is making sure that your care staff are happy, fully trained, competent and supported. Good staff are a valuable aspect of any care business, as they are the ones that have the everyday interaction with customers. This is where a good manager can help make the lives of care workers better: by continuously communicating and getting feedback on a regular basis on how they are doing in their daily work. Happy staff make happy customers. The inspector will want to speak with managers and staff members of all levels.
CQC inspectors don’t expect all staff to have the same knowledge but will expect them to understand their role in providing good outcomes for people and know what to do if they have concerns. Everyone in the service is responsible for a successful inspection, not just the manager.
Bluebird Care Westminster was recently awarded an ‘outstanding’ rating following an inspection in January 2018. The CQC inspectors found staff to be ‘kind, compassionate and caring’ and noted in their inspection report that the team ‘knew how to provide the care and support [people using the service] required whilst also going the extra mile for them’. The quality and commitment of the management at Bluebird Care Westminster was highlighted by the CQC, which said: ‘The provider had involved the whole staff team in driving improvement and had invested in staff and systems which created an open and positive culture throughout the service… the passion from the managing director was embedded throughout the whole staff team.’ The rigorous, high-quality training at the home was also remarked upon: ‘Care assistants received a comprehensive induction training programme to support them in meeting people’s needs effectively.’
Customers are your biggest asset
Customers are your biggest asset and the inspector will want to talk to them to get their views. Ask your customers if they would be happy to speak with an inspector. Ask them for their views on the KLOEs and what they feel are the business’s strengths and weaknesses. Inspectors will either visit customers with a member of staff or speak with them by telephone. They will cross-check what they see and hear against other evidence, such as care records, care plans, care notes, risk assessments and medication records or other information. They will be looking to determine whether regulations are being met or not, and where they see, hear or find proof to show that the care being provided is what they expect people to experience. This will then be included in the CQC report.
Bluebird Care South Somerset was inspected in March 2017 and received an ‘outstanding’ rating from the CQC. The report said: ‘The service used innovative ways to manage people’s risk and keep people safe, whilst ensuring they had a full and meaningful life. For example, enabling one couple living with dementia to enjoy an independent lunch in the community, whilst ensuring good communication with the venue and family. This showed the service balanced real risk and promoted independence and choice. People felt safe, had trust in the staff who visited them, building strong, caring relationships that mattered to people who knew who to contact if they were worried about their safety. One person said, "They make sure I have my call pendant on before they leave as I have fallen in the past, so they added this task to my care to ensure I am ok." Another person said, "I do feel very safe with them. I had a problem with my tablets and they just sorted it out." Relatives also commented on the relief they felt at being able to trust the service.”’
You might want to consider putting a short presentation together that you can deliver to your inspector about your service. This is a perfect opportunity for you to showcase yourselves and introduce the inspector to your service, your values, ethos and practice. Be clear, open and honest about what you do, focusing on your current plans and your future goals. Also prepare a folder with evidence that the inspector can take away with them. Make sure all areas including offices/receptions are clean and tidy. On the day, welcome the inspector and ask to see their identification badges. Do not allow anyone access without the proper authorisation or identification.
My final piece of advice is to be open and honest with inspectors about your service’s strengths and weaknesses. This will show them that you have identified areas of improvement and that you are working to make changes, with a robust action plan.
Use the following items in the Toolkit to help you put the ideas in this article into practice:
- Checklist – Ratings characteristics for key question 1 is the service safe (all providers) (premium plus)25.41 KB
- Checklist – Ratings characteristics for key question 2 is the service effective (all providers) (premium plus)21.72 KB @
- Checklist – Ratings characteristics for key question 3 is the service caring (all providers)20.07 KB
- Checklist – Ratings characteristics for key question 4 is the service responsive (all providers) (premium plus)20.77 KB @
- Form – Preparing for a CQC inspection (all providers)24.18 KB
About the author
Neil Murray is Head of Quality and Compliance at Bluebird Care, a provider of home and live-in care for people in their own homes. It has 15 offices that have been rated ‘outstanding’ overall. Neil has more than 22 years’ experience in social care settings across both local government and the private sectors, including franchising. He has managed a range of care provisions, including domiciliary care, day services, care homes and supported living, as well as undertaking business development and local authority commissioning.