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It can be daunting for care providers to think that a Care Quality Commission inspector could be on their doorstop at very short notice - usually in as little as 48 hours.
However, the good news is, that despite the short notice, care providers can prepare for the visit.
Familiarisation with the all-important assessment framework, coupled with an understanding of what will occur during the visit, will help things to go smoothly on the day, and could make a significant difference to future review ratings.
Understanding the new 2017 assessment framework
Laura Hannah is an associate solicitor within the Regulatory team at Stephensons Solicitors. She specialises in health and social care regulation. She recommends that understanding the assessment framework documentation is essential when preparing for a CQC visit. She says: “It is vital that providers familiarise themselves with this document prior to their next inspection to ensure that they understand what is expected of them.”
The five questions asked by the CQC about services are as follows:
• Are they safe?
• Are they effective?
• Are they caring?
• Are they responsive to people's needs?
• Are they well-led?
It's the registered care provider's job to help CQC inspectors find evidence that these five things exist within their provision.
These questions were first introduced in October 2014, and remain unchanged, but in 2017 a new set of Key Lines of Enquiry (‘KLOES’) were introduced for the sector as a whole.
According to Ms Hannah, the amended framework document “includes more KLOES than the previous version, with some new KLOES, particularly in relation to system leadership; integration and information sharing; technology; information governance and data security; medicines; end of life care and personalisation, social action and the use of volunteers.
“Some KLOES have also moved between the key questions and the wording of others have been changed to provide more clarity. However, much of the content remains the same, if not similar, overall.”
‘Documentary evidence is key to any inspection’
Paperwork doesn’t have to be provided before an inspection but according to the CQC website it can be given to the CQC during or after a visit.
Ms Hannah advises having it ready on the day. She says: “Documentary evidence is key to any inspection; if a provider is unable to demonstrate compliance, an inspector is unlikely to be satisfied that they are complying with their legal requirements.”
She also recommends that providers whose current internal policies, procedures or quality monitoring systems are based on the previous assessment framework, carry out a full review and immediately update where necessary. She says: “Some providers may find it beneficial to develop a compliance action plan which clearly sets out each new KLOE and evidences compliance with each.
“This can be provided to the inspector during an inspection and gives providers a basis upon which to answer the inspector’s questions. It also allows providers to identify any areas where they may be falling short and plan any necessary action prior to their inspection."
Another thing to do as soon as possible is to familiarise yourself with the CQC’s provider handbook, including the appendices in the ‘Guidance for providers’ section of their website. It explains all you need to know about how they inspect.
The CQC will normally send care providers a link to an online Provider Information Return, which will ask for service-based information, which needs to be sent back within four weeks.
On the day itself, much of the inspectors’ time will be taken up with looking at paperwork, or talking to staff, the residents and their families.
Ms Hannah has a few suggestions on how to prepare staff. She says: “Specialist assistance may also be sought from a specialist care consultant, who can conduct a mock inspection to identify any areas requiring improvement and provide practical advice on compliance prior to any inspection, as well as assisting with compiling an action plan to address any areas of concerns.”
Majority of UK adult social care services passing the ‘mum test’
In their recent report, published in October 2017, ‘The state of adult social care services 2014 to 2017’, the CQC compiled data from over 33,000 inspections of around 24,000 adult social care locations.
Interestingly, ‘Caring’ was the best rated key ‘question’ in the report, with 92 per cent of provision rated ‘Good’ and three per cent ‘Outstanding’.
Andrea Sutcliffe, chief inspector of Adult Social Care at the Care Quality Commission, said: "Most of the adult social care sector is meeting the 'Mum Test', providing safe and high-quality care that we would be happy for anyone we love, or ourselves, to receive.
“This is thanks to the thousands of dedicated staff and providers who work tirelessly to ensure people’s care is truly person-centred and meets their individual needs.”
The chief inspector did, however, state that there was “still too much poor care”, with some providers “failing to improve”. She went on to say: "It appears to be increasingly difficult for some providers to deliver the safe, high quality and compassionate care people deserve and have every right to expect. With demand for social care expected to rise over the next two decades, this is more worrying than ever.”
The report found that only two per cent of services were rated as 'Outstanding', but Ms Sutcliffe was quick to point out that she "made no apology for setting the bar high".