Getting ready for CQC changes
CQC's consultation sought views and opinion from providers and stakeholders on proposed changes to the frequency and intensity of inspections, improving the registration structure, and revising the fit and proper persons requirement. Now that all services have been inspected and rated at least once using the 'new' inspection regime, its aim is to fine tune and develop the registration, monitoring, inspection and rating process.
Changes to how CQC will regulate adult social care services
From 1 November 2017:
• CQC will be implementing a single assessment framework for all adult social care services. This combines the existing residential and community adult social care frameworks into one. These still focus on the five key questions ("KLOEs"), which ask whether a service is safe, effective, caring, responsive and well-led. However, some of the KLOEs and underlying prompts have been changed and new questions added. The characteristics for the ratings under each domain have also been updated.
We recommend that providers familiarise themselves with the new questions and characteristics in anticipation of their next inspection. A comparison document has been published to highlight the changes.
For example, a new KLOE in the safe domain asks inspectors to look at whether "lessons are learned and improvements made when things go wrong", which will require providers to have a robust system in place to record as well as measure changes made following accidents and incidents in the service. Simply logging incidents will no longer be sufficient without also being able to demonstrate what actions have been taken to prevent recurrence and how this has been shared with staff.
As part of the overall focus on accountability at management and provider level, there are also new KLOEs on whether a service is 'well-led', which focus on stakeholder involvement on the development and improvement of the service as well as inspecting how the provider ensures that its regulatory requirements are delegated to and understood by staff. This will place further emphasis on providers' obligations to seek out feedback and act on proposals.
• The new guidance for providers section of the website will replace the existing provider handbooks as an online resource centre for guidance on care standards, regulation, notifications and inspection. This guidance will be used by providers and inspectors alike with a view to simplifying the process and streamlining access to the various sources of information published online.
• Providers rated 'Requires Improvement' in two or more consecutive inspections will be required to complete and submit to CQC an improvement action plan to show how and by when they will improve their overall rating to 'Good'. This adds to the spotlight that is already trained on services perceived as being struggling to make improvements. We anticipate that this will continue to be an area of interest to CQC to ensure that services are deterred from coasting along from inspection to inspection without making significant improvement. In practice, we recognise this is rarely the case, but providers will have to take additional care to make sure that their record keeping and processes are up to scratch and that they are able to demonstrate the changes being made to address the problems identified and how the outcomes of those changes can be measured.
• More focused inspections will be carried out to address specific areas of concern or risks, in addition to regular comprehensive inspections which will still assess providers against the five key questions. Focused inspections, which can be carried out without notice following a safeguarding incident or whistleblowing notification, will produce a short report and can result in enforcement action. However, because the inspector is not assessing all five of the KLOEs, a focused inspection will not change the overall rating of the service.
Looking further ahead
From the start of 2018 and into the next financial year further changes will be implemented, including:
• Introducing a new online process for collecting information from providers. This is intended to replace the pre-inspection report process and will ask providers to self assess their service against the five KLOEs. This will be used to create a 'statement of quality' which will be used as a working document and will need to be updated annually, recording ongoing plans for improvement, even if the service is not due for inspection.
• Changing the frequency of comprehensive inspections, where CQC looks at all five KLOEs to award an overall rating. Services rated 'good' will be inspected after 30 months and 'outstanding' services after 36 months, while those rated 'requires improvement' will be inspected after no more than 12 months and 'inadequate' after no more than 6 months.
This will not prevent interim focused inspections on specific issues if CQC is notified of any concerns.
• Revising the 'fit and proper persons' requirement at director level. Revised guidance is intended to provide further guidance on what constitutes "serious mismanagement" and "misconduct" and how enforcement action will be deployed.
As part of CQC's ongoing programme of reviewing and updating its own systems and processes, we can expect further consultation on commissioning, particularly the movement from hospital to residential care. We would encourage providers to share their views and experiences with CQC in these consultations openly and honestly.
In the meantime, providers should take time to familiarise themselves with the new inspection questions and prompts. In particular, providers should consider whether their existing procedures are sufficient to demonstrate and evidence compliance during an inspection or as part of a factual accuracy challenge.