Changes to how CQC inspects and rates care homes
Care Quality Commission inspections
As a care home owner, it’s your legal obligation to meet the Care Quality Commission (CQC) standards ensuring residents’ health, safety and welfare.
CQC conducts regular inspections based on your home’s rating. CQC has now implemented their new assessment framework for care home providers in England, which differs in some aspects from the previous process.
About the CQC’S new assessment framework
What remains the same?
The CQC’s new approach to assessment continues to ask the five key questions, which apply to all health and social care services. The CQC asks if the services are:
- safe
- effective
- caring
- responsive to people’s needs
- well-led
The CQC will also continue to provide an overall location rating as part of its assessment. For each key question and the overall location rating the CQC will continue to apply its four-point ratings scale, awarding a rating of outstanding, good, requires improvement or inadequate.
Rating aggregation
CQC has provided additional clarity on how scores will be aggregated when they determine the overall service rating of a care home. The five key questions are all stated to be equally important and are weighted equally when determining the overall service rating.
For an overall rating of outstanding, a service will normally need to have both:
- At least two key questions rated as outstanding.
- The other key questions rated as good.
The overall rating will normally be good if there are both:
- no key questions rated as inadequate.
- no more than one key question rated as requires improvement.
The overall rating will normally require improvement if two or more key questions are rated as “requires improvement” and will normally be inadequate if two or more key questions are rated as inadequate.
How does the new framework differ from the previous approach?
There are several key differences in how CQC will assess the quality of services:
- Evidence gathering: CQC will expand information gathering beyond inspections to include various methods at different times, prioritising people’s experiences and shifting away from inspections as the main evidence collection method.
- Frequency of assessments: Evidence CQC collects or information it receives can trigger an assessment at any time. As a result, the rating of a service will no longer be the main driver when deciding when CQC next assesses a service.
- Assessing quality: CQC aims to assess quality more frequently by using evidence from various sources and reviewing multiple quality statements, rather than solely relying on inspections as currently done.
Quality statements replace CQC’s previous key lines of enquiry (KLOEs), prompts and rating characteristics. The quality statements are described by CQC as a set of commitments that providers are expected to live up to, highlighting what is needed to deliver ‘high-quality, person-centred care’.
Evidence categories
As part of its new approach to evidence gathering, and in order to make the results of assessments more transparent and consistent, CQC has grouped the different types of evidence they will consider during their assessments into six distinct categories. These are:
People's experience of health and care services
CQC defines people’s experiences as:
“a person’s needs, expectations, lived experience and satisfaction with their care, support and treatment. This includes access to and transfers between services”.
This is not limited to just people using the service, but also their families, friends, and advocates. Evidence collated can include phone calls with individuals, emails and completed feedback forms submitted to CQC, as well as feedback received by community groups, health and care providers themselves and local authorities.
Evidence may also be taken from groups representing people who are more likely to have a poorer experience of care, people with protected equality characteristics and unpaid carers
Feedback from staff and leaders
This is feedback from people working in a service, for a local authority or in an integrated care system, as well as groups of staff involved in providing care to people. It may also include evidence from people in leadership or management positions.
Examples of evidence CQC may consider include results from staff surveys, direct feedback from staff, interviews with staff or leaders, and whistleblowing.
Feedback from partners
This is evidence obtained from people who represent organisations that interact with the service provider in question, such as commissioners, other local providers, accreditation bodies and professional regulators.
Observation
Evidence obtained through observation on-site by CQC inspectors will remain an important cornerstone of any assessment. CQC may also rely on external bodies undertaking observations, such as Local Healthwatch.
Processes
CQC’s assessment in this regard will focus on how effective processes are to the relevant quality statement. CQC will consider data and information that measures how well such processes actually work. Examples include results from audits, findings and learning from safety incidents, access times for treatment and care, and case note reviews of people’s care and/or clinical records.
Outcomes
Assessment of outcomes considers how the service has affected people’s ‘physical, functional or psychological status’, with CQC considering aspects such mortality rates, emergency admissions and re-admissions, infection control rates, and vaccination and prescribing data.
Such evidence will not just be obtained at local service level, but from other wider sources such as national clinical audits.
