CQC Regulations & Standards for Health & Social Care Providers.

Delivering high quality services and achieving the best possible CQC rating is critical to your reputation as a care provider.

Advice on achieving CQC Standards

The health and social care sector is one of the most regulated industries to work within. This is in part due to the significant effect it can have on the people that use the service coupled with the vulnerability of the client group.

The regulation of care homes since 2000 have been evolving year on year, following the implantation of the Care Standards Act and latterly the Health and Social Care Act 2008.

CQC use many sources of information to build a picture of the health and social care settings they regulate. This includes inspection reports from other agencies such as local authorities, fire officers, environmental health inspectors, GP’s, Social Workers and District Nurses as well as members of the public. All this information is used along with notifications from the services as required by the health and social care act, including the annual return required to be submitted by providers known in England as the PIR. Other sources available are also logged such as information on company websites and social media. All this information builds a picture of a health care setting prior to an inspection taking place and helps to decide on the regularity and types of inspection required.

Regardless how excellent a service is; if there is no evidence to prove it the service risks getting grades less than they deserve. CQC rate services in five categories these are: Safe, Responsive, Caring, Effective and Well led. They use the single assessment framework KLOE’s to measure this. KLOE stands for Key Lines of Enquiry, and each of the five categories above have several I and we statements attached to them. Many have a cross over from one category to another. This means the registered manager of a service needs to understand the single assessments and framework have all the evidence to hand demonstrate compliance.

How can a Health and Social Care Consultancy such as Swift Management assist in this process?

Many service operators choose to use a care consultancy only when there is a problem to resolve but this could be a very short sighted view and whilst a care consultant is more than able to crisis manage, it is far better to engage their services to ensure their service is meeting standards, showcasing good practice and prevent the need for fire-fighting.

When looking at achieving CQC standards, increasing grades and demonstrating sustainable evidence Health and Social Care Consultants have a lot to offer. When we visit a service which has been rated inadequate, often staff, relatives and service users feel that the rating is unjust and is not reflective of the service they know.

Building the evidence is singularly one of the most important things any care operator can do, some of it is simple but time-consuming, other elements need skill and understanding.

Care providers can encourage service users and relatives to complete online surveys such as completing a response card to Carehome.co.uk or directly to CQC. Keep pictures of events in and around the service as evidence of what has been taking place. Keep thank you cards and letters, along with letters of complaint. It is always about balancing the view. Every inspector knows that no service is perfect.

Many of our clients have taken advantage of our staff and service user surveys; they are objective and are independently undertaken. They are anonymous and as such seen to be a far more reliable form of survey than one undertaken internally. The team at Swift Management are also able to benchmark the results against other providers.

Lesson learned are something CQC like to see and a simple response to the overall survey with a “you said” “we did” report to go with the results can go a long way in demonstrating that a provider takes what they hear seriously.

When a complaint is received, we can assist a provider in writing a response, which is meaningful appropriate and gives a clear indication of lessons learned. If the complainant is not satisfied again Swift Management can undertake an independent review. This is an option that shows transparency.

We can assist registered managers with our service inspections as these allow the service to showcase the evidence they have and make it easy for a manager to produce at the time of an inspection. As we have previously said no service is perfect therefore a high-quality service improvement plan is vital to showcase your service. We have a tried and tested formula for this, and our support can keep you on track. It helps providers complete their PIR and again shows how the service is well led.

Regulatory Notifications are a legal requirement, but when our consultants visit a service the registered manager is often not reporting everything they should, this is sometimes because they do not see an incident as reportable or they do not want to bring the services’ reputation down, due to making the notification. This could not be further from the truth. Transparency and openness are something that CQC find reassuring, it shows the service has nothing to hide, and that improvements are consistent and ongoing. Our team helps registered managers overcome this and assist where necessary in tying back the issue to the action plan, thus making the action plan a live document. This again demonstrates transparency.

Providing a great service should be the principle aim of every provider within the health and social care sector, achieving CQC standards is not difficult, it is proving how you do so that is the challenge. Swift Management Services can provide you with support that allows you to do both.

One comment often seen in inspection reports relates to care documentation and care plans. The report usually highlights that they are not person centred or they do not reflect the care that is being given. Our consultants can provide training and support around writing person centred care plans but also audit care plans and other care documentation to show that they all link together. Many providers see the risk assessments, care plans and daily records as three distinct records but they are not and need to work hand in hand.

We also see examples of care plans that are documents which are neatly maintained and kept up to date for reviews or inspections but, the staff on the frontline do not have any knowledge of the contents. Again, our team help by implementing systems to ensure documentation is not only correct and detailed but also in use.

Achieving CQC standards and improving your ratings is usually about transparency, lesson learned and knowing your business and addressing issues. Our team of consultants at Swift Management are highly experienced in all these areas and can really make a difference which is why we have a package to support health and social care establishments meet the standards without breaking the bank.

When a service, receives an inadequate rating they usually receive a embargo from commissioners a significant reduction in referalls, the private market may fall away as people read your report and staff leave because they feel they do not want to be associated with an inadequate service, there is also usually an element of bad press. For example: In an average 60 bed care home, receiving an inadequate rating can cost as much as £300k in lost revenue, increased training and agency costs etc therefore prevention must be better than cure especially for those people using your service.

CQC Standards for Health & Social Care Services

The basis of CQC inspection is the single assessment framework. They apply to all services within the Health and Social Care sector. The industry needs to ensure they meet the standards laid down within the act.

The team at Swift Management services have specialist health social care consultants which assist services to meet the standards and increase their ratings. Every Health and Social Care service will be measured against five key elements, Safe, Caring, Responsive, Effective and Well Led. Ensuring services meet the standards required in all elements of the inspection process can be complex for providers. The consultants within our team work with providers to ensure that the CQC standards are met in a your service and there is evidence of good practice to support this. A well-managed service with good evidence of meeting the standards will afford a provider with a much better rating.

Advice on CQC Regulation

CQC is the regulatory body who regulates all Health and Social Care providers across England. The basis for CQC regulation is the Health and Social Care Act. Providers of Health and Social Care need to navigate the act and comply with it. The team at Swift Management Services work with all sector providers; from Care Homes, Ambulance Services, GP & Dental practices, Domiciliary Care Agencies Private Hospitals and Hospices to offer practical advice and support in compliance with the act and support with the regulators.

It is important that providers comply with regulations, provide high standards of care and governance and be able to prove that is what they do, by maintain good records. One of the best ways of ensuring a provider is meeting CQC regulation is maintain a live working service improvement plan. It is best practice for providers to monitor themselves against the single assessment framework used by CQC in the regulation process, document where evidence of compliance can be found and ensure that where a shortfall is identified it is part of the service improvement plan so that it is addressed in a realistic timeframe.

CQC Regulation Care Homes

CQC is the regulatory body who regulates all Health and Social Care providers across England. The basis for CQC regulation is the Health and Social Care Act. Care Home Providers need to be able to interpret the act, meet the standards as well as manage their business. This can be a big task especially when faced with an inspection report which was not as expected. The team at Swift Management can support service providers with all aspects of service regulation, carry out single assessment process review providing a comprehensive report, detailing where evidence can be found and what the shortfalls are. This can be translated into a service improvement plan.

We are also able to provide support to service providers when the Regulators have decided to take enforcement action. We offer a comprehensive service, which assists in making swift and sustainable change to a service, thus reducing the risk of reputation damage and enforcement action.

CQC regulation commences with the registration of a new provider or service. Once registered this process is ongoing. Providers can find the process difficult to navigate and time consuming.

We can assist with all registration issues, and once registered any issues as they arise. Many of our clients make contact when less than favourable situations have occurred. We recommend discussing regulatory issues as early as possible in the process; do not wait for things to go too far.

We provide support and advice on the completion of factual accuracy submissions, which are both timebound and evidenced based. This means expertise in this area is vital, as the evidence you provide can make all the difference to your appeal.

Our team are able to offer advice on Notices of Proposals and Notices of Decisions, assist in preparation of action plans, and provide support to bring them to fruition. Prompt decisive action is required, and we have managed these situations before, where for many providers this will be the first time.

The way potential providers or current providers present themselves to the regulators is vital as it can instil confidence and reduce risks. We offer services from mock inspections to full regulatory support with issues. The aim of the mock inspection is to identify and assist you to rectify issues before a regulatory inspection. We provide the service with the evidence base they need to ensure a fruitful regulatory inspection.

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Frequently Asked Questions

As part of the Well led and safe categories, it is important to be able to prove there is good dialogue between the registered manager and the senior management team, to show that the issues in the services are known and understood at the right level in the organisation, and the registered manager has the resources to make any changes required.

Document discussions and meetings, formally record your visits, if not every visit but try to hold one formal visit a month. Ensure your manager keeps you updated and if this is done by an email you can evidence this. Have a service improvement plan and demonstrate it is regularly reviewed.

In short your processes should be robust enough that there are no surprises that come out after the event.

Analysing trends, for example analysing the number of resident falls, is there a patten to them around time of day location etc. If there is a patten, is there something you can do to prevent them occurring in the future. Do you need to review staff deployment or purchase falls detection equipment. When you have done the review document you have done it and what your finding were.

When a complaint is received they should be logged. An investigation should be undertaken and a response formulated. Within that response the complaint should be substantiated or not substantiated. The outcome should also be logged and where the complaint is substantiated the action taken to prevent a reoccurrence should also be implemented and recorded. A strong paper trail really is vital dealing with a complaint. Remember your complaints policy and stick to the timeframes within it.

Your policies and procedures are key, measure outcomes against your policies and where required update your policies to reflect the service. In many instances when an issue occurs the actual action will be measured against what the policy says, and difficulties start when they are not aligned.

We are able to carry out a variety of audits and evaluations which we can provide to boards of directors or providers. This will ensure that shortfalls are identified and known by the board, this may be regular governance visits or a one off mock inspection.