The Care Quality Commission (CQC) is the organisation which regulates health and social care providers in England (Scotland and Wales are regulated by the Care Inspectorate). The CQC ensures that their required standards are being met. Care providers include hospitals, GP services, clinics, care homes, domiciliary care (home care), dentists, mental health services, hospices, community-based services and ambulances.
The checks made are stringent, and the Care Quality Commission has powers to issue warning notices, fines and prosecute cases where an individual has either been harmed or was in danger of being harmed.
The purpose of the Care Quality Commission is to monitor, inspect and rate health care providers in England in order to regulate a nationwide set of minimum standards. This ensures that the people using the service (Service Users) are kept safe.
Care providers & CQC regulation
Every care home in England needs to be registered with the CQC. For home care (domiciliary care) however, it depends on whether they are classed as a regulated or introductory agency. Introductory agencies do not manage the care, employ the Carers directly or have an ongoing involvement in the care. They will instead introduce you to a suitable Carer who you will employ and manage directly. These types of agencies do not need to be registered with the care quality commission.
Regulated providers on the other hand make up the majority of care providers in England and will employ their Carers directly and manage the care ongoing. The following areas of care are classed as regulated activities meaning that an agency who is providing physical assistance with this type of care will be required to be registered with the CQC:
o Personal care (bathing)
o Eating or drinking
o Toileting
o Dressing
o Oral care
o Hair or nails due to the person’s age, disability or illness
o Skin care
For further clarification on regulated vs unregulated providers, you can view the CQC’s definition of regulated vs unregulated care providers.
Regulated provider or introductory agency?
There is no right or wrong answer here. There are a number of factors to consider whether you would choose to use a regulated provider or introductory agency. These include:
- The person receiving the care (Service User): If the person receiving the care has complex needs and or the care rota requires a number of Carers, then perhaps a regulated provider who has the resources, skills and experience to manage this type of care would be more appropriate. If the Service User has little care needs and is able to manage the Carer themselves, an introductory agency may be a better fit.
- Price: Regulated services tend to be more expensive than introductory services due to the higher regulatory pressures and increased admin / work force in adhering to and managing these.
- Time / support: You may not have the time to manage the Carer yourself and prefer to use a regulated provider who will manage this for you. If the person receiving the care does not have any family / support nearby, using a regulated agency who can manage this for you may be required.
How does the CQC rate service providers?
Each provider will be given a rating (outstanding, good, requires improvement or inadequate) on five key areas of their business (safe, effective, caring, responsive and well led). These ratings will then culminate into one overall rating.
- Outstanding: Only 5% of home care providers and 3.5% of Care Homes in England are rated as outstanding (accurate as of October 23). Organisations who are rated as outstanding satisfy not only the requirements expected by the Care Quality Commission but also go above and beyond this. An example of this could be hosting dementia awareness training for families of a loved one suffering from Dementia.
- Good: The service is performing well and meeting the expectations. Around 80% of home care and care home providers are rated as good.
- Requires Improvement: The service has areas in their business which require improvement. An example of this could be regularly not using the correct medication administration record when giving medication, inadequate or inaccurate record keeping following the care of a Service User or a care plan which is out of date (missing changes in condition).
- Inadequate: Should the CQC find a serious breach of regulations, they may rate the care home or home care provider as inadequate. An example of this may be a care provider not carrying out the required criminal checks (Disclosure and Barring Service) resulting in a Carer who is barred from working with vulnerable adults being placed with one.
Providers who are rated as ‘requires improvement’ or ‘inadequate’ will be given an action plan of improvements to make before the CQC comes back and inspect again (usually done in a quicker time frame than they would normally do). Some providers who are rated as inadequate may have restrictions placed on them taking on new clients until they have been inspected again.
How do I view a regulated provider’s CQC report?
All regulated providers are required to have their CQC ‘widget’ (digital interactive summary of findings) visible on the home page of their website (usually at the bottom). You can also use a website like Compare Caring where you will be able to view the services offered by each care provider as well as the CQC widget showing the rating for each regulated provider (unregulated providers / introductory agencies will not have one of these). You can click the widget to be taken into the CQC’s website where you can read the full report.
You can also go directly to the Care Quality Commission’s website and view provider information and inspections reports from there. Do bear in mind that new providers may not have been inspected in which case their CQC widget will state this.
Example CQC widget
The CQC rating is a good guide but does not always tell the whole story so it is always important to do your own research when making a decision. The CQC reports are easy to read and very user friendly so if you have any queries after reading the CQC report, ask the provider directly and see what they say. You can usually get a good feel for the provider by being open and honest about your concerns and hearing their response.
Why do healthcare providers need to be regulated
Regulation is in place to limit the risk of harm to the public when receiving treatment or care. The Care Quality Commission’s main objectives are to protect the public, maintain confidence in health provision and uphold professional standards.
In particular, with an aging population, the requirement for care, either domiciliary or in a nursing/care home has become ever more in demand. In recent years many more private companies have formed to cater to the trend in providing home care services.
The Care Quality Commission is invaluable to all service providers to know what standards are required and for a new company embarking on providing health care services there is a framework in place for what is expected.
What happens when the CQC carries out an inspection
Depending on the type of inspection, care providers are notified in advance of a forthcoming inspection, however, sometimes the visit will be unannounced. There may be a team involved in the process, or it may just be one person carrying out the visit.
The site visit involves meeting initially with senior managers, gathering feedback from service users, checking records, documents and viewing the policies and procedures, and speaking to staff members.
Findings and feedback are shared with the senior managers before the rating is published, together with any plan for the necessity of further inspections if the service is found to be failing in some way.
How does a Service Provider prove to the Care Quality Commission it is meeting expectations
The need for robust systems has never been greater for health care providers to be able to prove that they are able to offer the services they claim. Sometimes the need to maintain written records can seem laborious and time-consuming, but it is essential that they are kept and be fit for purpose in order to comply with the requirements of the Care Quality Commission.
The CQC will look at and rate five key areas of the care providers business
- Safe: Prospective staff are vetted by interview, employment references are carried out and disclosure and barring service (DBS) checks are completed prior to employment. Induction training to include safeguarding, moving and handling and medication administration. Staff are trained in how to fill out the necessary forms and the importance of detailed record-keeping. There are systems in place to monitor and supervise staff to ensure they are carrying out their duties to a high standard, and procedures in place to improve where needed.
- Caring: Staff are trained in person-centred care which encompasses all aspects of the skills and qualities staff are required to possess in order to provide excellence in care. These include understanding awareness of safe and discreet ways of working without loss of dignity. Staff are trained to encourage and promote autonomy, empowerment and independence. The importance of understanding difference and diversity when providing care is essential, in other words one size does not fit all, the Service Users are individuals who will be shown respect and not judged by anyone. They are at the heart of all decisions made with regard to care given.
- Effective: Care plans are written with the service user where possible, gathering personal information to create a document which is easily understood by carers and the knowledge therein assists all the staff to provide care which is tailor-made to that individual. Staff are aware of their responsibilities in treating all Service Users with respect and dignity.
- Responsive: Systems should be in place for regular updates to the care plan so any changes can be incorporated quickly. Lines of communication should be open between staff and supervisors so that any urgent changes are implemented immediately. Service Users are always involved in reviews of care plans so their wishes are carried out and staff know they have to read care plans at each visit in case of changes. Service Users know who they can contact in the organisation when they need to.
- Well-led: All staff are aware of their duties, responsibilities, what actions to take in different situations, how to contact someone if a challenging event occurs, staff are confident and happy carrying out their tasks, knowing they are supported by Supervisors and Managers. The staff receive on-going training throughout their employment and are offered opportunities to further their careers such as obtaining qualifications to support their role.
The Care Quality Commission benefits not just the Service Users but gives peace of mind to care agencies and employees knowing that they are operating within best practice guidelines. The organisation has the power to look searchingly into all aspects of the way a service provider operates, therefore creating high standards which have to be achieved and maintained.
For more information on the CQC, see here
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