The Care Quality Commission (CQC) acts as an independent regulator of health and social care.
Its inspection regime aims to ensure that the quality of care provided is fit for purpose.
CQC inspections can be a daunting prospect for organisations, but don’t panic – by taking the necessary steps beforehand, the process can run smoothly.
What should I expect?
On average, CQC inspections typically last two days but can be shorter or longer depending the size of your organisation.
Inspections may be carried out by a single CQC inspector or a team, who will attempt to gain a rounded picture by talking to your managers, frontline staff and service users, including their relatives.
The regime provides four ratings, ranging from outstanding to inadequate, but has “zero tolerance” for services where care is poor. As the CQC’s consultation document states, it will “always be on the side of people who use services”.
How do I prepare?
It can be unnerving to think that a CQC inspector could soon be at your doorstep. However, the good news is that with a little preparation, you can be ready for a visit whenever it occurs.
As an essential starting point when preparing from an inspection, you should make sure that you have read and understood the 2018 assessment framework. This will help to make clear what is expected of you so that you can lay the necessary groundwork. It could also make a big difference to your rating, so it’s worth taking the time to familiarise yourself with its contents.
Alongside this, you should take a look at the CQC’s website, including the ‘Guidance for providers’ section, which explains the CQC’s inspection procedures.
Once you’re clued up on what to expect, you should ask yourself: what do I do really well that I want to showcase and tell the inspectors when they call?
When should I expect a visit and how much notice will I be given?
The CQC use your previous rating to determine when to inspect your service:
- If your service is rated ‘inadequate’, the maximum interval between inspections is six months.
- If your service is rated ‘requires improvement’, the maximum interval between inspections is 12 months.
- If your service is rated ‘good’ or ‘outstanding’, the maximum interval between inspections is five years.
In other words, the better you perform at inspection, the less you will have to worry about involvement from the CQC.
So as not to disrupt the care you provide, CQC inspections are usually unannounced. In some cases, you may be given two weeks’ notice, where an inspector will telephone your practice to announce the inspection and send a letter to confirm the date; however, you shouldn’t bank on this being the case. You may also receive an unannounced inspection in response to a particular issue or concern. It’s therefore wise to be inspection-ready at all times.
What will the inspection focus on?
The key areas of the inspection regime are safety and leadership. The CQC’s 2017/18 state of care report mentions specific concerns surrounding poor safeguarding training and lack of evidence of risk management.
With this in mind, it’s vital that your organisation is well-led and has a registered manager in place to lead the service and provide clear direction.
Be aware of the 5 key questions the CQC will always ask about your services
Are they safe?
Your service must protect from abuse and avoidable harm.
Are they effective?
Your care, treatment and support should achieve good outcomes, and help maintain quality of life – based on the best available evidence.
Are they caring?
Your staff should treat people with compassion, kindness, dignity and respect.
Are they responsive?
Your service should be organised to respond to people’s needs.
Are they well-led?
Your leadership, management and governance should ensure your organisation provides high-quality care based around individual needs. It should also encourage learning and innovation, and promote an open and fair culture.
Your role is to help CQC inspectors find evidence that these five things exist within your service provision.
Key lines of enquiry
To assess how your service performs in relation to each of the five key questions, inspectors will follow key lines of enquiry or ‘KLOE’.
For example, in relation to question one, inspectors might look at how risks are identified and managed in order to help them understand whether your service is safe.
In order to reach a rating, inspection teams gather and record evidence in order to answer each KLOE.
The CQC report that using KLOE helps them to be consistent in what they look at under each of the five key questions, and allows them to focus on the areas that matter most. This also allows for a credible, comparable rating across all organisations.
What evidence will I need to provide?
Documentary evidence is key to any inspection – if you are unable to demonstrate compliance, an inspector is unlikely to be satisfied you are complying with the legal requirements.
As CQC visits are typically unannounced, you are not required to provide paperwork before an inspection, but you may be asked for more information during or after a visit, so it’s always advisable to have it ready.
You should:
- Keep a record of how your service works with stakeholders, what surveys are carried out and how people are able to influence decisions.
- Maintain a CQC folder of relevant information to show inspectors. This should contain your policies, procedures and good news stories, such as positive feedback/compliments from families, pictures, details of projects and manager newsletters.
You may also find it useful to develop a compliance action plan that clearly sets out each KLOE and evidences compliance with each. Such a plan may help you to:
- Provide a basis on which to answer an inspector’s questions;
- Identify any areas where you may be falling short; and
- Plan any necessary action prior to inspection.
CQC Deputy Chief Inspection, Debbie Westhead
5 top tips for preparing for a CQC inspection:
- Speak to patients. Put together an action plan based on what patients report about their experience of using the service and how it meets their needs – this will show that you’re listening to your service users, which is exactly what the inspection is intended to assess. It will also allow you to collect examples of good practice to prove what makes your service outstanding.
- Make sure staff are prepared. All staff should understand the role of the CQC, its fundamental standards, and what to expect from an inspection. They should also be up-to-date with the service’s protocols, so refresher training may be useful.
- Don’t be afraid to acknowledge problems. Assess the risks that your service presents to patients – this will demonstrate that you have recognised these areas and thought about how to address them.
- Get everyone involved. Inspections shouldn’t be just left to the Registered Manager and/or Practice Manager. All staff should work together to prepare for an inspection by discussing any adverse events that have happened in the past 12 months, reviewing the action taken and generating ideas for improvement.
- Consider carrying out a mock inspection. This can be carried out by an external company or a competent person within your service, who should speak with staff, managers, visitors and patients. It should assess the five key areas and provide a truthful view of the service from which a continuous improvement plan can be devised.
Ultimately, while staff may be worried about the CQC visiting, you should encourage them to see it as an opportunity to present what they achieve on a day-to-day basis.
Need help?
Our specialist Health & Safety Consultants support over 400 care providers in the UK. If you need advice and assistance when preparing for CQC inspections, your named consultant will:
- Conduct a mock inspection to identify any areas requiring improvement;
- Provide practical advice on compliance prior to inspection; and
- Help compile an action plan to address any areas of concern.
For more information, call 0345 226 8393.
