The Care Quality Commission, inspections and CQC ratings
What is the CQC?
The Care Quality Commission (CQC) is the independent regulator of health and social care in England. Its job is to make sure health and social care services provide people with safe, effective, compassionate, high-quality care and to encourage care services to improve. CQC ratings are used to measure quality across services.
What does the CQC do?
- Registers care providers
- Monitors, inspects and rates services
- Takes action to protect people who use services
- Speaks with an independent voice, publishing its views on major quality issues in health and social care
Through its work it:
- Protects the rights of vulnerable people, including those restricted under the Mental Health Act
- Listens to and acts on service users’ experiences
- Involves the public and people who receive care
- Works with other organisations and public groups
How does the CQC inspect care providers?
The CQC conducts inspections which are an important part of regulating health and social care providers in England. This usually consists of site visits, which allows it to observe care and to look at people’s records to see how their needs are managed.
What do CQC inspections involve?
During inspections, the CQC asks people about their experiences of care, talk to care staff, and checks that the right systems and processes are in place.
Inspectors work to establish whether the standards are being met or not, and publish reports of findings on its website.
The CQC also requires providers to complete the provider information return (PIR) which is a snapshot overview that details any changes made and evidence to show that the service is safe, effective, caring, responsive and well-led.
In between inspections, the CQC monitors all the information from the public, care staff, care services and other organisations.
A transitional approach in response to Covid-19
During the Covid-19 pandemic, the CQC has altered its Emergency Support Framework to a Transitional Monitoring Approach (TMA) targeting specific areas under the key lines of enquiry. This focuses on safety, how effectively a service is led and how easily people can access the service.
Broadly, the TMA consisted of CQC gathering information about a service, making a monitoring call, and following the call, sending a monitoring summary record.
And while was not an inspection, it helped the CQC to decide whether further regulatory action is needed. The focus of the TMA was on monitoring risk and was used to decide whether further regulatory action needed to be taken, for example, an inspection.
In September 2020 the CQC announced it would be piloting virtual inspections with willing domiciliary care providers. Gathering evidence through the use of technology, such as videoconferencing and care management systems.
The CQC outlined full details of its new digital approach in its strategy document – ‘The world of health and social care is changing. So are we.’
Following this, the CQC provided details about its response to the consultation on flexible and responsive regulation – which indicated a high level of support for reviewing and updating ratings more flexibly.
How is the CQC changing its approach to regulation?
The big news for 2022 is the Care Quality Commission’s announcement in July of its new approach to regulation. It ushers in major changes to the way the CQC works to deliver its ambitious new strategy (revealed May 2021). The key changes for care providers are:
- A new single assessment framework – covering all services. It has been shaped around what matters most to people who use health and social care services, along with families.
- Quality statements will replace the key lines of enquiry – these “we statements” are designed to demonstrate what high-quality, person-centred care looks like.
- The five key questions will remain the same – with 5-9 quality statements sitting under each of the familiar assessment areas of Safe, Effective, Caring, Responsive and Well-led.
- The current four-point ratings system will stay the same – care providers will continue to be marked as Inadequate, Requires Improvement, Good or Outstanding in each of the five key question areas, as well as overall.
- Ratings can be changed at any time – new information can change a rating, with the CQC collecting a much broader range of data from care providers, national data sets and other sources. This means more flexible and frequent assessments.
- Inspections remain a vital tool – but are no longer the only source of information when assessing a service. Data will also be used to decide when to inspect, rather than sticking to a rigid schedule.
- Six new evidence categories – introduced as a way of organising information. They are: people’s experiences, feedback from staff and leaders, feedback from partners, observation, processes and outcome measures.
- Evidence scoring – to make judgements more structured and consistent.
- Shorter and simpler reports – showing the most up-to-date assessment.
- Registration to be based on the same single assessment framework – making registration the first assessment activity for care providers in an integrated regulatory process.
How does the CQC rate care providers?
In most cases, inspection reports include a rating. These can help users compare services and make choices about care.
There are four ratings – and the CQC will give a rating for each key question as well as an overall rating for the service.
What are CQC ratings?
- Outstanding – The service is performing exceptionally well. staff are delivering an exceptional and innovative service with a culture that considers imaginative ways to manage risk and increase people’s opportunities. Careworkers are supported to find creative ways to support people to live a full life and can build strong relationships with service users and their families.
- Good – The service is performing well and meeting expectations by delivering an effective and consistent level of care. The provider has demonstrated a robust quality assurance system, which shows a focus on quality, lessons being learned and staff being held to account.
- Requires improvement – The service is not performing as well as it should and has been told how it must improve. Quality of care is not consistently safe, and care isn’t provided in line with the latest legislation, guidelines and good practice.
- Inadequate – The service is performing badly and action has been taken against the person or organisation that runs it. The provider is in breach of one or more regulations and is not meeting some of the fundamental standards. Service users are receiving care that may be unsafe, careworkers are not supported.
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