The CQC consultation is progressing at pace. We have put together a brief overview of the proposed changes and what they may mean to care home operators.
The proposed changes are very much in draft form and these will change but highlighted below are the main points of interest to you as a provider below.
1. Essential vs. Fundamental Standards
The Essential Standards will be changing to the Fundamental Standards-
|Essential Standards Fundamental Standards|
|9 Care and welfare of service users 4 Person-centred care|
|10 Assessing and monitoring the 5 Dignity and respect|
|quality of service provision 6 Need for consent|
|11 Safeguarding service users from 7 Safe and appropriate care and treatment|
|Abuse 8 Safeguarding service users from abuse|
|12 Cleanliness and infection control 9 Meeting nutritional needs|
|13 Management of medicines 10 Cleanliness, safety and suitability of premises|
|14 Meeting nutritional needs and equipment|
|15 Safety and suitability of premises 11 Receiving and acting on complaints|
|16 Safety, availability and suitability 12 Good governance|
|of equipment. 13 Staffing|
|17 Respecting and involving service users 14 Fit and proper persons employed|
|18 Consent to care and treatment 17 Offences|
|21 Requirements relating to workers|
|23 Supporting workers|
|24 Cooperating with other providers|
2. The five key questions
There will be five key questions that Homes will be inspected against and these will be:
– Are they safe?
– Are they effective?
– Are they caring?
– Are they responsive to people’s needs?
– Are they well led?
3. Key Lines of Enquiry (KLOE)
To direct the focus of CQC inspections, the inspector will use a standard set of key lines of enquiry (KLOEs) which directly relate to the five key questions.
Amongst the set of standard KLOEs, CQC have identified 13 mandatory KLOEs which will be assessed at every inspection. These mandatory KLOEs have been put in place with the view to ensuring consistency of inspections. The inspection team will use these and a minimum of four others.
However, one thing to note is that when we drill down and look at the Key Lines of Enquiry (KLOE), you will see a lot of overlap between the questions. This means that, potentially, a small issue in a Home could be magnified across the whole inspection but, equally, any positive practice may also be magnified.
For example, when we look at care planning, we can see that out of the 26 KLOEs, 14 relate in some way to care planning and span four questions, Safe, Effective, Caring and Responsive. This might mean any issues with care planning could have a fundamental impact on the overall outcome of an inspection, even if the other areas of the inspection are positive.
When we look at respect and involvement, we see that this comes up in 16 KLOEs which spans all five questions.
This is something that will no doubt come up in the consultation so it may be that the questions and/or KLOEs change. However, if they were to change, there would be little chance that CQC would be ready to roll out their new model in October 2014 as proposed.
4. Provider Information Response
One major change is the return of the pre-inspection questionnaire or Provider Information Response (PIR) as it will be called. There is some debate at the moment, and this is part of the consultation, as to whether providers will be asked to complete these returns annually or 6 weeks before an inspection.
Its approach is more of a narrative one than the old pre-inspection questionnaire and providers are asked to declare compliance for each question, with a 500 word ‘guidance’ for all but the Well-led question which is currently 2,500 words.
It also asks you to provide factual details in a number of other areas such as staff turnover, reason for employees leaving, number of agencies hours etc.
This will form part of the ‘Intelligence Gathering’ section of CQC’s new model. Along with information gained from the PIR, notifications, resident/relative/staff feedback and community links, the team will decide which KLOEs they will review during the inspection.
5. Registered Manager (RM) Vacancy
This is an area CQC has put high on its new agenda and they have been very quick of late to issue enforcement notices to those Homes that have had a Registered Manager vacancy for some time. In the last 12 months CQC have issued 590 enforcement notices because of this and 42% of operators paid the fixed penalty notice of £4,000 (£991,200).
In June 2013 there were 3,900 Homes with no RM, with a quarter of these not having had a manager for over 2 years. Figures which were published just yesterday from the CQC board showed that since CQC have taken tougher action on operators, 1,395 of these Homes now have a RM in place with a further 470 applications in process.
6. The Inspection
CQC propose that there will be two types of visits, Comprehensive; where CQC will review the Home in relation to the five key questions, and Focused; a follow up from a previous inspection, or to respond to a particular issue or concern.
The Inspection team will be bigger and it has been suggested it could be anything from three to eight people. However, the latter is unlikely due to current CQC resource on the ground.
We are led to believe that, as a minimum, there will be a lead inspector, an expert by experience (usually a volunteer) and a specialist inspector (such as a Pharmacist or a Dementia specialist).
Inspectors will hold a sit down meeting with managers at the start of the inspection where they will outline which KLOEs they will be reviewing during the visit, what documents they wish to review and who they will be speaking to.
At the end of the visit, ALL inspectors will now provide feedback. Whilst they won’t give you a rating at this point, they will go through their findings. It is important that managers are trained to deal with this feedback session effectively. This is their opportunity to challenge the findings in more of an informal manner and managers should not be shy about doing this. Once the inspection team have left the building, it will be much harder to challenge any CQC outcome.
6.1 Inspection Frequencies
CQC are saying that from October 2014 the frequency of planned inspections will be linked to ratings as follows:
– Inadequate return within 6 months of last inspection
– Requires improvement return within 12 months of last inspection
– Good return within 18 months of last inspection
– Outstanding return within 24 months of last inspection
In addition, they will also inspect 10% of randomly selected ‘good’ and ‘outstanding’ rated Homes each year.
Ratings are the new approach and CQC say that every Home, by April 2016, will have been rated. It is rumoured that these ratings will directly impact on LA ‘quality premiums’ from 2016, if not before.
Homes will be rated as Outstanding, Good, Requires Improvement or Inadequate. At present, there is some debate around the ‘Inadequate/Good’ boundaries. As you will see below, CQC are implying that a ‘Requires Improvement’ rating could be given to a compliant Home and that a Good rating relates to a ‘Compliant +’ situation. Clearly this seems somewhat unfair and a little misleading.
In the new approach, there are certain “limiters” for each key question which, if found to be relevant to the service, that key question cannot be rated better than “requires improvement”. An example of the “limiters” for the ‘Are they well-led’ question is below:
Your rating will be an aggregate of the five questions; you don’t have to be ‘outstanding’ on all five questions to gain an ‘outstanding rating’. See below.
|The rating principles|
|The five key questions have equal ‘weighting’ and contribute equally to the overall location rating.|
|Overall location ratings are produced using principles that show what the aggregated, overall rating is for all the possible combinations of five key question ratings. These principles are:|
|1. If two or more of the key questions are rated ‘inadequate’, then the overall aggregated rating will normally be ‘inadequate’.|
|2. If one of the key questions is rated ‘inadequate’, then the overall rating will normally be ‘requires improvement’.|
|3. If two or more of the key questions are rated ‘requires improvement’, then the overall rating will normally be ‘requires improvement’.|
|4. At least two of the five key questions would normally need to be rated ‘outstanding’ before an aggregated rating of ‘outstanding’ can be awarded.|
Previously CQC could not prosecute against the regulations without first providing a warning notice. Legalisation is now changing and this will no longer be the case. CQC will have more powers and will be able to proceed straight to prosecution without warning.
However, as the draft regulations are written currently, they leave little room for prosecution unless there is a fundamental and severe issue with the service. The consensus is these will be tightened up over the next few months.
We hope you have found this brief overview useful, however please do not hesitate to contact us if you have any questions about the above or anything else about the imminent changes. The Little Group provides independent quality and regulatory audits and support Homes across the UK including completion of PIRs.
For more information contact Stacey on 01484 365363 or firstname.lastname@example.org