The CQC has now implemented a new single assessment framework and all health and social care providers will be assessed under this framework moving forwards. Whilst it is still based on an assessment of the five key questions of safe; effective; caring; responsive and well-led, each key question now has a set of quality statements. There are also six evidence categories which the CQC will focus on when assessing a quality statement, with the number of those looked at varying depending on the type of service and assessment.
The existing ratings of outstanding, good, requires improvement and inadequate have remained the same, however, there is now a scoring system, which assists the CQC in determining the ratings for each key question. When assessing evidence, the CQC will assign a score to each evidence category under a quality statement, all of which are then combined to give an overall score for the quality statement. The scores for all of the quality statements are then further combined to create an overall percentage, which is subsequently converted into a rating for the key question.
You can view our recent blog which explains the CQC’s new single assessment framework and scoring system in more detail here.
Preparing for your assessment
This new assessment framework is still in its infancy and has been widely criticised by many already, however, the CQC hope that their new scoring system will provide more transparency and consistency in their judgements and enable services to see if quality or performance is moving in the right direction within a rating.
There are a number of steps which providers and managers can take to ensure that they are prepared for their next inspection or assessment under this new framework:
Before an inspection:
1. Familiarise yourself with the CQC’s new assessment framework
It is vital that providers and managers understand how the CQC’s new single assessment framework works in practice and particularly, the scoring system. There are various online resources available to assist with this, both from the CQC and from other organisations and professionals operating within the health and social care sectors, including specialist solicitors and compliance experts. However, providers should also make sure they are always consulting the most up-to-date online CQC guidance and ensure that any printed copies are regularly reviewed and updated, as guidance is likely to be refined and updated regularly.
Providers may also find it beneficial to develop a compliance action plan which clearly sets out each quality statement within each key question and evidences their compliance with each, with reference to the relevant evidence categories. This can be provided to the inspector during an inspection and can prove useful to providers when answering 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. 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.
2.Staff awareness and training
Individual staff employed at a service should also have a good understanding of how the CQC are now assessing services under this new assessment framework so that they understand the purpose and process of an inspection. An inspection is often a very nerve-racking experience, especially for those staff who have never faced an inspection before. It is important that providers prepare staff on what to expect during an inspection and ensure that they are fully trained on every aspect of the service, as well as how to speak to inspectors. The inspectors often spend a great deal of time observing and speaking to staff and it is therefore vital that staff feel as comfortable as possible in these situations, know how to react, and feel comfortable about answering questions confidently.
3. Feedback
As over half of the CQC’s evidence categories relate to feedback from service users, staff and other stakeholders, it would be advisable for providers to consider their current processes for obtaining feedback and how they record this. In addition, providers should consider what procedures they have in place for acting on any feedback received and sharing this where necessary, to achieve and demonstrate good outcomes for people.
Providers should not wait for feedback to be provided to them; a proactive approach to feedback is sensible. Not only will this enable providers to keep a detailed record of any positive feedback received to share with the inspectors, but it will also enable them to identify any potential issues and act on any concerns before they escalate.
How this feedback is presented is also important; it needs to be clear, easily accessible and in an easily read format, which is kept up-to-date and compiled from a variety of sources and people. However, providers should not stop there – you should be thinking about how this feedback is evidenced with reference to examples and linking this back to any good outcomes achieved for people, another one of the CQC’s evidence categories.
4. Make sure your registration details are up-to-date!
This may be a minor point but it is important that your registered details and contact information are up-to-date so that the CQC can contact you about your assessment and subsequently send their assessment report.
It is also important to ensure that your registration remains sufficient for the regulated activities you are undertaking and the services you are providing, and that you are fully complying with any conditions of your registration, otherwise this could lead to unnecessary enforcement action.
During and after an inspection:
We have previously found that many providers’ challenges arising from inspections have related to evidence or information not being considered by an inspector during an inspection. It is therefore vital that providers do not make the presumption that an inspector will only ask to review a particular document or ask a certain question if they need to. It is important that a provider asks questions and volunteers information or evidence throughout an inspection where necessary.
Any requests for information during or after the inspection should also be dealt with promptly and efficiently, providing comprehensive evidence in an easily accessible and readable format. If certain information or documents are contained off-site or are not immediately available, providers should take all steps possible to obtain this information and at the very least, make them aware of their existence and provide them to the inspector as soon as practicably possible thereafter.
Providers should also not be afraid to ask for feedback during an inspection. It may be that this leads to further vital information being provided or it enables a provider to immediately address any compliance issues that have been identified. Additionally, if you do not understand an issue, seek clarification as this will help you to better respond to or address their concern more effectively.
Finally, if you are able to do so, it is always advisable to take notes during an inspection, so you have a record of what has been said in the event that you need to challenge any of the inspector’s findings. It also helps providers to recall certain information which they may not have done otherwise given the pressure of the inspection.
Challenging an inspection report or rating
Following an inspection, providers are issued with a draft inspection report which includes the ratings and scores awarded to their service for each quality statement and key question and an overall aggregated rating, where applicable. Providers are given ten working days from receipt of the report to challenge the factual accuracy and completeness of the evidence within the report.
After a report is published, providers can request a review of any ratings within 15 working days of publication of the report. However, the only ground for requesting a review is that the inspector has not followed the process for making ratings decisions and aggregating them.
Both of these remain important processes and should be utilised by any care provider who is not satisfied with the CQC’s judgments or ratings, as these could be used as the basis for enforcement action. However, it is important that providers have solid grounds for any challenge, with each challenge set out clearly and concisely and supported by robust documentary evidence to stand any prosect of success.
Contact our specialist CQC solicitors
Our specialist lawyers have extensive experience of successfully challenging inspection reports and ratings, achieving an increase in individual and overall ratings and the removal of regulation breaches. You can read more about how to challenge a CQC inspection or assessment report or rating here.
If you have received an assessment under the CQC new single assessment framework and you wish to challenge the CQC’s findings, judgments, scores or ratings, you can contact our specialist CQC solicitors now for a confidential, no-obligation discussion on 0161 696 6250 or via our online enquiry form.
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