The Care Quality Commission (CQC) recently implemented its new single assessment framework which has made a number of significant changes to the way it inspects and rates health and social care providers, including a new scoring system. You can read more about this new assessment framework, including the rating and scoring system here.
If you have received an assessment under the CQC’s new single assessment framework, and you are unhappy with the CQC’s judgments or ratings, you should review the below guidance on how you can challenge a CQC draft assessment report or rating.
Factual accuracy check
Prior to the publication of an assessment report, providers are given the opportunity to challenge the accuracy and completeness of the information used by the CQC to formulate their judgements and ratings. Providers will receive an email with a link to review their draft assessment report, which can be read online or downloaded.
Providers are given ten working days from the date on which they receive the email with the link to the draft assessment report to submit any factual accuracy comments. Extensions to this period are not granted unless there are exceptional circumstances, and these must be outlined to the CQC in writing without delay. It is therefore vital that providers seek specialist advice as soon as they receive their draft assessment report.
Factual accuracy comments can be made in the following areas:
- Typographical or numerical errors;
- Information that has contributed to a judgement, but which you believe is factually inaccurate.
- Additional information, or information that was omitted, which you think should be considered.
At this stage, it is important that providers make detailed and supported challenges to any judgments within the draft assessment report that are not factually accurate or consistent with the CQC’s new assessment framework and guidance.
The first point is self-explanatory and is unlikely to lead to any significant changes within a draft assessment report. However, to stand any prospect of being successful in a challenge concerning the remaining two points above, any factual accuracy comments need to be supported by robust documentary evidence from the time of the assessment. This can include any additional information not considered during the assessment, but which existed at the time of assessment and which may support a different judgement or rating than that awarded. Where evidence is relied upon, providers should ensure that they direct the CQC to the specific page or part of the document which supports the point made.
It is also important to note that any evidence which relates to concerns raised directly with the provider during the assessment and/or evidences action taken following the assessment will not form part of the CQC’s decision in relation to their final judgements or ratings, except in exceptional circumstances. However, the CQC will consider whether the assessment report needs to be amended to reflect this new, post-assessment information.
Before making any factual accuracy comments, providers should consider whether they require any further information or clarification on any particular inspection judgments before making their factual accuracy comments. Any requests for information should be sent directly to the assessor and must be clear and concise with reference to the reasons why this is needed. This is a vital step as the CQC have made clear that an assessment report does not need to reference all of the evidence relied upon, and only needs to include ‘the best evidence’ to support their judgements. Further clarity on the evidence relied upon for a particular judgment may therefore be necessary for any successful challenge, where on the face of it, the stated evidence does not appear to support the overall judgment or justify the score or rating awarded.
Whilst challenging a CQC assessment report or rating is an important step, providers do not always submit factual accuracy comments even where they are not satisfied with the accuracy or completeness of a draft report. This may be because they do not think it will make a difference or in some cases, they do not wish to aggravate matters with their assessor. This is entirely the wrong course of action and prompt and proactive action should be taken by all health and adult social care providers wherever there is a reasonable and viable challenge supported by clear evidence, particularly whilst the CQC itself is still in the initial stages of rolling our this new assessment framework. Any factual accuracy comments should also be considered by a member of CQC’s staff who is independent of the original assessment.
If no challenge is made to a draft assessment report and it is subsequently published, there is a presumption that the contents of the published report is entirely accurate. There is also no record that a provider has challenged any of the judgements within the assessment report, which may then be used by the CQC as the basis for taking civil or criminal enforcement action. It is also much more difficult for providers to dispute the need for enforcement action on the basis of unchallenged assessment findings.
The CQC state within their guidance that the factual accuracy checking process should not be used to challenge an assessment rating or score solely on the basis that a provider disagrees with it; how the assessment was carried out; or any proposed enforcement activity. However, in our experience, it is vital to note your concerns in this regard as sometimes these matters will be relevant to the overall comments being made and the reasons why the judgments are factually inaccurate.
Ratings process review
Once any factual accuracy challenge has been responded to, a provider will receive a final copy of the assessment report before it is published.
After the assessment report is published, a provider can request a review of the quality control processes followed when an assessment results in a rating being published. The only ground for requesting a rating process assurance review is that the CQC has failed to follow their published processes for scoring an assessment and making rating decisions. You cannot request a review solely on the basis that you disagree with the judgements made or the score or rating awarded by the CQC, nor can it be used as a process for complaining about enforcement action.
A request for a rating process assurance review must be submitted to the CQC via an online form within 15 working days of the publication of the rating and not before publication. Only one request for a rating process assurance review can be made per assessment and the request must relate to the latest published assessment, awarding the current ratings.
The CQC will first consider whether the request for a review falls within the permitted grounds and if so, the review will be dealt with by CQC staff who are independent from the original assessment. It is, however, important to note that if the CQC do not uphold a request for review, you are unable to lodge a subsequent request to review the ratings of the same assessment.
It should also be noted that a ratings review can result in an increase or decrease in the current ratings and the full request is limited to 500 words in total. Due to this word limit, ratings reviews are difficult to obtain and there is no guarantee that a request will result in a change in the ratings. However, this is the only route a provider has to attempt to change any rating arising from a recently published assessment and put their concerns on record.
The CQC aim to complete all reviews within 50 working days and during this time, any assessments and ratings remain published on a provider’s CQC profile, although a message will be displayed on the profile to confirm that a review is taking place.
Whilst success with these types of reviews has historically been difficult, an unreasonable or disproportionate rating can negatively affect a provider’s reputation; financial standing; and/or contracts and it is therefore vital that any challenges which are supported by clear evidence and meet the relevant criteria are pursued. In the most serious of cases, where a negative rating escalates to enforcement action, clear challenges to the factual accuracy of a draft assessment report and the published ratings can provide helpful evidence in any appeal against such enforcement action.
Our specialist CQC lawyers can help you
At Stephensons, our specialist CQC lawyers regularly represent health and social care providers nationwide who are challenging CQC inspection reports and ratings during the factual accuracy and ratings review processes. In particular, we have achieved success at persuading the CQC to amend, and even remove, parts of an inspection report prior to publication, as well as withdraw entire reports from publication and re-inspect. We have also successfully challenged multiple ratings at both stages, which in some cases has resulted in the overall rating of a service being changed from ‘requires improvement’ to ‘good’.
Our experienced CQC lawyers have also successfully challenged breaches of the 2014 regulations during the factual accuracy process, which has resulted in an increase in one or more ratings. You can view our CQC case studies for more details about some of our recent cases.
If you have received a draft assessment report or wish to challenge your ratings, our specialist CQC lawyers can assist you with compiling a robust and detailed response to the CQC to place you in the best possible position. For a confidential discussion with one of our specialist CQC lawyers, please contact us on 0161 696 6250 or complete our online enquiry form.
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