Care Quality Commission FAQ’s

19 December 2019

Care Quality Commission FAQ’s discussed by Bristol Care Homes

The Care Quality Commission is an important and imperative organisation which ensures that our health and social care services in the UK are safe, effective and compassionate and that they provide high-quality care to their patients. Our Quality Care Commission FAQ’s will tell you everything you need to know about them and the service they provide.

(some of the information from this article has been sourced from the Care Quality Commission website)

What is the Care Quality Commission?

The Quality Care Commission (CQC) is the independent regulator of health and social care in England.

What is the Purpose of the Care Quality Commission?

Their purpose is to make sure health and social care services provide people with safe, effective, compassionate and high-quality care by monitoring, inspecting and regulating health and social care services, encouraging care services to improve. They publish what they find which includes ratings to help people choose their care service supplier.

What is the Care Quality Commission’s role?

Registering care providers
Monitoring inspecting and rating care services
Taking action to protect people who use care services
Speaking with independently and publishing views on major quality issues in health and social care

What does the Care Quality Commission do?

Protect the rights of vulnerable people, including those restricted under the Mental Health Act.
Listen to and act on your experiences.
Involve the public and people who receive care
Work with other organisations and public groups.

What are the values of the Care Quality Commission?

Excellence – being a high-performing organisation
Caring – treating everyone with dignity and respect
Integrity – doing the right thing
Teamwork – learning from each other to be the best we can

What is the vision of the Care Quality Commission?

A more targeted, responsive and collaborative approach to regulation so more people get high-quality care.

How is the Care Quality Commission run?

The management structure is headed by a board which is supported by the executive team.

The board members of the Care Quality Commission are the senior decision-making body within the organisation which provides leadership and ensures they are successful and sustainable, sets strategy, purpose and values.

The Care Quality Commission Executive team are responsible for the day-to-day running of the organisation and oversee the delivery of the business plan objectives, ensures resources are used properly as well as managing the teams and individual performance.

Who does the Care Quality Commission work with and alongside?

The Care Quality Commission works closely with other organisations that manage and oversee the health and social care system so they can spot, and stamp out, bad practice within health and social care providers and services together.

They do this by:

Sharing information about services
Improving how care is overseen
Making the most of joint resources and activities
Reduce duplication

We have joint working agreements with different organisations including:

Care in the criminal justice system – Working with other inspectorates to monitor the quality of health and care within secure settings.

Children’s Services – Working with Ofsted and other inspectorates to inspect registered health services for children.

Working with local groups – Working with others to make sure we hear the views and opinions of people who use services.

They also work with national charities to gather feedback from people about their experiences of care within the UK.

Who is regulated by the Care Quality Commission?

The Care Quality Commission monitor, inspect and regulate services that provide health and social care by monitoring and regulating the following activities:

Treatment, care and support provided by hospitals, GPs dentists, ambulances and mental health services
Treatment, care and support services for adults in care homes and in people’s own homes (both personal and nursing care)
Services for people whose rights are restricted under the Mental Health Act

What are the standards set by the Care Quality Commission?

They have fundamental standards and these are the standards which care must never fall below.

Person-centred care – You must have care or treatment that is tailored to you and meets your needs and preferences.

Dignity and respect – You must be treated with dignity and respect at all times while you’re receiving care and treatment.

These include making sure:

You have privacy when you need and want it.
Everybody is treated as equals
You’re given any support you need to help you remain independent and involved in your local community

Consent – You (or anybody legally acting on your behalf) must give your consent before any care or treatment is given to you.

Safety – You must not be given unsafe care or treatment or be put at risk of harm that could be avoided. Providers must assess the risks to your health and safety during any care or treatment and make sure their staff have the qualifications, competence, skills and experience to keep you safe.

Safeguarding from abuse – You must not suffer any form of abuse or improper treatment while receiving care including:

Neglect
Degrading treatment
Unnecessary or disproportionate restraint
Inappropriate limits on your freedom.

Food and drink – You must have enough to eat and drink to keep you in good health while you receive care and treatment.

Premises and equipment – The places where you receive care and treatment and the equipment used in it must be clean, suitable and looked after properly. The equipment used in your care and treatment must also be secure and used properly.

Complaints – You must be able to complain about your care and treatment. The provider of your care must have a system in place so they can handle and respond to your complaint. They must investigate it thoroughly and take action if problems are identified.

Good governance – The provider of your care must have plans that ensure they can meet these standards. They must have effective governance and systems to check on the quality and safety of care. These must help the service improve and reduce any risks to your health, safety and welfare.

Staffing – The provider of your care must have enough suitably qualified, competent and experienced staff to make sure they can meet these standards. Their staff must be given the support, training and supervision they need to help them do their job.

Fit and proper staff – The provider of your care must only employ people who can provide care and treatment appropriate to their role. They must have strong recruitment procedures in place and carry out relevant checks such as on applicants’ criminal records and work history.

Duty of candour – The provider of your care must be open and transparent with you about your care and treatment. Should something go wrong, they must tell you what has happened, provide support and apologise.

Display of ratings – The provider of your care must display their CQC rating in a place where you can see it. They must also include this information on their website and make our latest report on their service available to you.

Although we inspect and regulate different care services in different ways, there are some things we do that apply across all services.

What does the Care Quality Commission’s regulation of care services involve?

Registering people that apply to provide services
Using data, evidence and information throughout their work
Using feedback given to help them reach their judgements
Inspections are carried out by experts
Publishing information on judgements and outcomes. In most cases publishing a rating to help you choose a care provider
Taking action when it is judged that services need to improve or to make sure those responsible for poor care are held accountable for it

What should you do if you or someone you know is receiving poor care

If you or someone you know experiences poor care, you should contact the service provider in the first instance. The Care Quality Commission’s role as the regulator means that they don’t settle individual complaints themselves, however, they still want to know about experiences of care received.

What does Safeguarding mean?

Safeguarding is protecting people’s health, wellbeing and human rights, enabling them to live free from harm, abuse and neglect which is fundamental to high-quality health and social care.

What does Safeguarding mean for children who use care services?

Protecting them from maltreatment or things that are bad for their health or development
Making sure they grow up in circumstances that allow safe and effective care

What does Safeguarding mean for adults who use care services?

Protecting their rights to live in safety, free from abuse and neglect
People and organisations working together to prevent the risk of abuse or neglect, and to stop them from happening
Making sure people’s wellbeing is promoted, taking their views, wishes, feelings and beliefs into account

How does the Care Quality Commission safeguard people?

They use the information they receive (particularly when concerns are raised about abuse, harm or neglect) to look at the risks to people who use specific care services
They refer concerns to local councils and/or the police for further investigation
They carry out inspections which include talking to people who use the services to help them identify any safeguarding concerns
They publish their findings on safeguarding in their inspection reports which anyone can view
They take action if they find that care services do not have suitable arrangements to keep people safe
They work with partners such as the police, local councils, health agencies, other regulators and government departments and share information
They take part in multi-agency children’s safeguarding inspections to get a picture of children’s and young people’s experiences and how well they are being safeguarded

What authorities do the Care Quality Commission work with?

NHS Trusts (including ambulance trusts)
NHS Foundation Trusts
NHS England (who hold a statutory responsibility)
Other health providers, including primary care and providers in the independent sector, are not specified and do not hold a statutory responsibility.

Why do care providers need to register with the Care Quality Commission?

A care provider has to register with the Care Quality Commission and they are checked that they meet a number of legal requirements which include fundamental standards of quality and safety satisfactorily before they can carry out any of the care activities that are regulated.

How does the Care Quality Commission assess the care providers which apply?

They look at information about applicants of the care provider and the services they intend to provide and they make judgements based on:

Whether they think they are suitable
Whether there are enough staff and if they have the right skills, qualifications and experience to provide the care
The size, layout and design of the locations where the care will be provided
Their policies, systems and procedures and how effective they will be
How they are run and how they plan to make decisions

How does the Care Quality Commission monitor care services?

When a service has registered with the Care Quality Commission they are then monitored continuously to gather information on how the care services are performing between inspections.

There are five questions that are asked of all care services which ensures the regulation is consistent and focuses on the things that matter to people being cared for.

Are they safe? (Safe: you are protected from abuse and avoidable harm)
Are they effective? (Effective: your care, treatment and support achieves good outcomes, helps you to maintain quality of life and is based on the best available evidence)
Are they caring? (Caring: staff involve and treat you with compassion, kindness, dignity and respect)
Are they responsive to people’s needs? (Responsive: services are organised so that they meet your needs)
Are they well-led? (Well-led: the leadership, management and governance of the organisation make sure it’s providing high-quality care that’s based around your individual needs, that it encourages learning and innovation, and that it promotes an open and fair culture)

How does the Care Quality Commission use the five key questions in their Care Provider inspections?

The five key questions are broken down into a further set of questions and they call these their key lines of enquiry. They are used to help support decisions on what they need to focus on. The key lines of enquiry help them ensure consistency in what they look at under each of the five key questions and that the most important areas which matter most are focused on.

How are the Care Quality Commission inspections planned?

The Care Quality Commission ensure they have all of the right information before they carry out a care provider inspection which helps keep them consistent and focus on the right and important things. The preparation can influence what they look at, who they talk to and how the inspection team is put together. The information gathered before the inspection as evidence is also used when deciding the care providers ratings.

What information is gathered before an inspection?

This can depend on the type of service they are inspecting and includes:

Comments received through phone calls, letters and emails or through a form to give care feedback
Information from local Healthwatch and other organisations
Feedback from activities planned to encourage care feedback
Information from any staff who raise concerns
Information from the care provider

Who is involved or carries out the care provider inspections?

The inspection team can include specialists such as clinicians or pharmacists and or experts by experience which have personal experience of care, from using care services or because they have cared for someone who has. The size of an inspection team and who is in it depends on the type and size of service they are inspecting.

As an example, an NHS trust inspection could have an inspection team of up to 50 members, including clinical and other types of experts. For a smaller care home, it can be a single inspector and often an expert by experience.

Where are the evidence and information sourced from before, during and after the inspection?

Local information that is collected continuously, including complaints and information given by staff, carers and people who use services
Information that is collected prior to the inspection, such as information from the service provider or from the Care Quality Commission’s records
Local and national data
Observations of care and looking at records and documents during the inspection

Adult social care services, such as care homes and home care companies the sources are slightly different as less data is available for adult social care compared to other care services and include:

A range of data, including local information
Information that is collected before the inspection
Information gathered from speaking with people who use services, their families, carers, staff and other professionals

How does a care provider know when they will be inspected?

Inspections are announced in advance for certain care services and not announced for others. The Care Quality Commission website allows you to see any planned inspections.

Why does the Care Quality Commission carry out inspections?

Visiting care services is an important part of the inspection process and gives the inspection team an opportunity to talk to staff and people who use the services as well as allowing them to observe care happening and look at people’s records to see how their care needs are managed.

What are the different types of inspections?

Comprehensive inspections are carried out on health and social care services to ensure care providers are providing care that is safe, caring, effective, responsive to people’s needs and well-led.

How frequently they are inspected, the size of the inspection team and whether or not the care provider is given notice of the inspection depends on the type of service being inspected.

Focused inspections are smaller in scale to comprehensive inspections, although they follow a similar process.

Why are focused inspections carried out?

To look at something that has been raised as a concern during a comprehensive inspection or through monitoring work
If there is a change in a care provider’s circumstances; a takeover, merger or an acquisition

A focused inspection doesn’t always look at all key questions and the size of the team and who is involved will depend on what it is looking at or into.

What is looked at in different types of service inspections?

There are some differences between the things that are looked at in different types of care services and providers. For example, when an NHS trust is inspected eight core services are looked at. When a GP practice is inspected, they look at how the practice provides services to particular population groups. The five key questions are applied to each of these areas.

How is evidence gathered before, during and after an inspection?

The inspection team uses key lines of enquiry and information from the planning stage to plan and structure their visit, focusing on areas of concern or areas where the service is performing particularly well. The inspection team collects evidence against the key lines of enquiry by:

Gathering the views of people who use services which includes:

Speaking to people individually and in groups
Using comment cards placed in GP surgeries or busy areas in hospitals
Staffing pop-up engagement stalls before NHS acute hospital trust inspections
Using information gathered from complaints and concerns from people who use services
Gathering information from staff

Other inspection methods include

Observing care
Looking at individual care pathways
Reviewing records
Inspecting the places where people are cared for
Looking at documents and policies
Feedback

At the end of the visit, the inspector or senior members of the inspection team hold a feedback meeting with senior staff and will:

Give a summary of what has been found during the visit.

Highlight any issues or areas of concern that have come up
Identify any action the service provider needs to take immediately
Outline any plans for further announced visits
Explain how the judgements have been made and will be published

The Care Quality Commission investigation outcome reports set out the findings for each of the five key questions. It describes the good practice found, as well as any concerns identified as well as clearly setting out any evidence in regards to breaches of regulations. The report also makes recommendations to help the care provider improve its rating.

Quality Control

The Care Quality Commission aim to be consistent in everything they do and now have a quality assurance panel to look at samples of their rating judgements to check for consistency.

Action Planning

The care provider has to respond to areas of concern that we have identified in the report and develop an action plan to address them and make improvements and this is followed up by the Care Quality Commission to make sure the actions are being taken and improvements are being made by contacting them or carrying out a new and focused investigation.

When the Care Quality Commission inspects acute hospital trusts, specialist mental health services and community health services, their findings are discussed at a quality summit which is a meeting with the care provider and partners of the local health and social care system.

Ratings

In the majority of cases, the Care Quality Commission inspection reports include ratings and these help people with care needs, or family members with care needs compare services and make choices about care and care providers.

There are four ratings that are given to health and social care services: outstanding, good, requires improvement and inadequate and these ratings are given for each of the five key questions as well as the care provider or service being given an overall rating.

Outstanding – The service is performing exceptionally well.

Good – The service is performing well and meeting our expectations.

Requires improvement – The service is not performing as well as it should and we have told the service how it must improve.

Inadequate – The service is performing badly and we’ve taken action against the person or organisation that runs it.

What services do the Care Quality Commission not give ratings for?

Currently, dental practices are not given ratings and some service ratings are not published, however, this will change in the future.

How do you know the rating that a care service or provider has been given?

Care providers have to display the ratings they are given by law and in the places where the care is provided so that the people who use the services can see them easily. This can be in the main entrance or in a waiting area. They also have to show their ratings on their website, if they have one.

What action does the Care Quality Commission take?

Everybody has the right to receive safe and high-quality care and if we find that care has fallen short of this, we use our powers to take action against those responsible. The Care Quality Commission will:

Protect you from harm and make sure you receive care that meets the standards you have a right to expect
Make sure services improve if the standard of care they provide has fallen below acceptable levels
Hold care providers and managers accountable for failures in how care is provided

The action taken depends on how the problems identified will affect the people who use the service and how serious they are and the action they can take includes:

Using requirement notices or warning notices to set out what improvements the care provider must make and by when
Making changes to a care provider’s registration to limit what services they can offer in the form of imposing conditions for a specific time
Placing a provider in special measures, where their care is closely supervised and monitored whilst working with other organisations to help them improve within specific timescales

They will hold the care provider to account for their failings by:
Issuing cautions
Issuing fines
Prosecuting cases if people are harmed or placed in danger of harm

Any actions taken against a care service or provider are clearly shown in our inspection reports and on the care provider’s pages on the Care Quality Commission website to ensure you are aware of them if you are considering care with them.

About Bristol Care Homes

We are a small group of 4, high-quality care homes in Bristol who’s dedicated team provide quality and caring services every day. Our founding vision is to provide excellence in all aspects of care for all our residents.

Our service leads the way in care home provision and our Care Quality Commission Ratings are:

Glebe House – Outstanding Glebe House Care Home Bristol CQC

Beech House – Outstanding Beech House Care Home Bristol CQC

Field House – Good Field House Care Home Bristol CQC

Quarry House – Good Quarry House Care Home Bristol CQC

We are always looking to be innovative in our services and we offer many features which will help you or your loved one to maintain a high level of fulfilment in your life at each of our care homes. Many of our services are unique to Bristol Care Homes and all include:

Beautiful gardens with plenty of greenery, trees and flowers
Environmentally designed buildings with 24/7 air circulation always keeping the atmosphere fresh and airy
Spacious rooms with increased ceiling height which gives the feel of openness
Wide corridors for ease of access
Television, DVD Player and direct line telephones in each room
Internet access in residents rooms
Customised top quality wheelchairs provided when needed
High technology baths and walk-in showers
Minibus services with a regular schedule of trips
Regular maintenance and replacement cycles of new carpets and decoration
Top Quality chefs producing tasty, varied and nutritious meals
Programme of interesting and stimulating activities for all our residents
Nurses on duty 24 hours a day, 365 days a year