Challenging CQC inspection reports and ratings

CQC factual accuracy challenge

Before a CQC inspection report is published, providers are given the opportunity to challenge the accuracy and completeness of the evidence on which the inspector’s ratings and judgments are based. The factual accuracy challenge is separated into three sections:

• Typographical or numerical errors

• Accuracy of the evidence

• Additional or omitted information that should be considered

Providers are given 10 working days from the date on which they receive the draft report by email to submit any challenge. Extensions to this period are not granted unless there are exceptional circumstances and these are outlined to the CQC in writing. It is therefore vital that providers seek specialist advice as soon as they receive their draft report.

At this stage, it is important that providers make detailed and supported challenges to any findings within the draft report that are not accurate or consistent with the CQC’s assessment framework and guidance. However, it is important to note that, for a challenge to stand any prospect of being successful, it must be supported by clear documentary evidence, which was available to the inspectors on the day of the inspection. Where evidence is relied on, providers should ensure that they direct the CQC to the specific page or part of the document which supports the point made.

Evidence which was not available on the day of the inspection, but that demonstrates any action taken since the inspection to address any concerns raised, can also be submitted at this stage. Whilst the CQC can amend the report to reflect this new information, it will not usually form part of the CQC’s decision in relation to their final judgements or ratings, except in exceptional circumstances.

Whilst challenging a CQC inspection 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 inspector. This is entirely the wrong course of action; providers should always make clear, robust challenges against draft inspection reports, where they have solid grounds to do so and can back up any challenge with robust documentary evidence. If no challenge is made to a draft 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 findings within the inspection report, which is often used as the basis for a decision by the CQC to pursue enforcement action. It is also much more difficult for providers to dispute the need for enforcement action on the basis of unchallenged inspection findings.

CQC ratings review request

After an inspection report is published, a provider can request a review of the ratings within the final inspection report. The only ground for requesting a review is that the inspector did not follow the correct process for making ratings decisions and aggregating them.

A ratings review request must be submitted to the CQC using the appropriate online web form within 15 working days of publication of the report; it cannot be made before publication.

It is important for providers to be aware 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 after the report is published. This means that the factual accuracy process is even more important as the CQC will reconsider any factual accuracy challenge made when considering a ratings review.

When making a ratings review request, providers must state which particular ratings they want to be reviewed, as well as the grounds upon which they are requesting the review. Providers only have one opportunity to submit a ratings review request and it is therefore vital that this is completed correctly, any subsequent request in respect of the same inspection report will not be considered by the CQC.

After the CQC make their decision on a ratings review request, their decision will be sent to a provider in writing. If a rating has been changed, the published inspection report will be removed from publication and replaced with the new, amended version. In some circumstances, where more than one rating has changed and it has resulted in significant changes to the report, the CQC may decide to remove the report entirely and undertake a completely fresh inspection.

Whilst success with these challenges is sometimes difficult, if a request is not made, providers may have to wait some time before their published ratings are reviewed or a further inspection takes place. During this time, their ratings will remain unchanged and may negatively affect their reputation; financial standing; and/or contracts. In the most serious of cases, where a negative rating escalates to enforcement action, clear challenges to the factual accuracy of a draft report and the published ratings can provide helpful evidence in any appeal against such enforcement action.

How can we help you?

At Stephensons, our specialist CQC lawyers regularly represent care providers nationwide 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 changed the overall rating of a service from ‘requires improvement’ to ‘good’ and from ‘good’ to ‘outstanding’. 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 page here for more details on some of our recent cases.

If you have received a draft inspection report or wish to challenge your inspection ratings, we 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 call us on 01616 966 229 or complete our online enquiry form.