By Debbie le Quesne

Archive for the ‘cqc regs’ Category

Industry focused on compliance more than care?

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Caring Times editor, Geoff Hodgson’s blog is always welcome. Recently he recalled the story of his time working as journalist in the goldfields of Western Australia.

The narrative he told is a sad one about an old gold prospector who blew himself up rather than be moved from his ramshackle shanty to be looked after, at the state’s expense, in a care home.

At 80-something he had become “very frail and it was clear he could not continue to live independently,” Geoff recalls.

Moving into a care home is never easy and Geoff rightly observes that it is the loss of independence that is such an “anguished step”.

Good residential care environments indeed do have the potential to give people true independence, options, choices and a more fulfilled lives than they would have if they remained at home.

I agree wholeheartedly with Geoff on this assumption, but only, as he puts it “if they’re allowed to”.

We have possibly the most regulated industry in the world and for most smaller providers, all they’re trying to do is make a legitimate living at providing good care.

I genuinely fear that our caring sector is turning into an industry focused on compliance and regulation, rather than care. These two essential of staying in business are huge money-makers in their own right and we can’t deny the expertise being offered by these relatively new players in caring.

Ironically, I envisage a continuing growth in regulatory framework, while the industry it serves becomes progressively smaller.

No ordinary life is without risk. Each day offers new risk choices for all of us and mostly we navigate them safely.

Such is the risk analysis of life in residential care, few tricky decisions can happen instantly. But it is often that spontaneity that defines life and just like Geoff blogged, the danger is that people like his old gold prospector will “continue to make their own arrangements”.

If the demands of governance are such that all spontaneity on decision-making is stifled, people like Billy surely will continue to make their own arrangements.

CQC fees: How can they demand to be self-funding?

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Now the The Independent Care Group that serves York and North Yorkshire is calling on the regulator to rethink its planned hike in fees or risk damaging social care. Dead right! At West Midlands Care Association we too are furious and are clearly concerned what implications such a move will have on the sector.

An article in the online magazine Care Industry News says the proposed rise in the fee providers have to pay will add thousands to already stretched budgets.

In the case of homecare providers the increase would be 313 per cent phased over two or four years and for care home owners a huge rise, again phased over similar periods.

The group’s Chair, Mike Padgham, is reported as saying that the proposed rise comes at a time when social care was on its knees and was totally unacceptable.

Quote: “Social care is at an all-time low, with £4bn cut from budgets in recent years, fewer and fewer people receiving the care they need and providers going out of existence,” he said.

“Providers are already having to plan for the introduction of the National Living Wage next spring, without enough funding in the sector to pay for it. For this huge rise in the CQC fee to come on top is adding insult to injury and could be the final straw for many providers.”

And sadly it will be the final straw. David Benham, the chief exec. with CQC has made it clear her wants full recovery of costs, thus making the regulator self financing.

Quite how he has the gall to demand this, knowing that full cost recovery for care providers is not happening with local authorities, astounds me.

I need strong coffee – and chocolate: Always a bad omen!


Failings report: The other news behind the headlines

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The BBC has picked up on a media release from the Care Quality Commission, reporting that nine sites have been rated inadequate across the north of England.

Some 41 visits in that region had taken place at the time of the newsbreak (April7).

It all makes depressing reading with incidents of faeces on a sofa and a window sill, walls and furniture stained, damp dining chairs and sliding bolts found on the outside of doors. What!

You may think that this news (see www.bbc.co.uk/news/uk-england-32204389 ) is CQC flexing its muscles to sends out a very clear message to those homes where standards are not so good.

Perhaps, that in part, is true – frankly, neither myself or the West Midlands Care Association which I head would ever condone substandard care – but the cases highlight for me another issue and probably a bigger one.

For too many years care providers delivering residential packages have been deprived by local authorities of realistic rates for beds.

Some councils have pegged fees, some have offered minor increments, a few in more affluent areas of the UK have dispensed better deals, while others have been challenged in the courts over chronically poor payments.

This financial deprivation has effectively forced the hand of many providers to keep their quality mark at a safe level, but not at the excellence that many would wish. Safe, indeed, not exemplary . . . it’s what’s being paid for, and has been paid for even in the years of plenty when LAs saw fit to spend budgets on other items they deemed more important tan caring.

With fiscal restraint continuing to look bleak even post-General Election, there appears to be no money left for the poor care provider who must continue to maintain safe care with no extra resource.

Of course, I’m not defending the failing homes, but I would like to think the Commission really did understand the root cause of many of the problems that its enthusiastic diligence will disclose.

I wonder too just how many homes will fall at the new CQC hurdles because of bad paperwork and poor audit trails. Ironic, isn’t it, that this Government body is fast uncovering the results of its own master’s policies.

Add to this the top-heavy procedures of implementing DoLS and safeguarding, we have a growing pool of homes where ratings are bound to plummet.

I’m not surprised with the emerging outcomes, especially when the standard required to achieve ‘good’ has significantly shifted upwards.

Like most things in life, you get what you pay for.

Here’s a snapshot of the West Midlands picture:

Good  Requires        Inadequate


Dudley Care Homes                         3               8                             2

Sandwell Care Homes                    12              10                           0

Wolverhampton Care Homes        4                   5                            1

Walsall Care Homes                        2                 3                            0

Birmingham Care Homes                35            17                             2

Worcester Care Homes                  13              5                              0

Totals                                              69            48                              5

lease note well: Worcestershire, with its better figures, pays better than the other Midlands authorities and there are also more privately funded service users in that region to subsidise those whose care is paid for by the local authority.

Ratings posters edict seems heavy-handed

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With downloadable options for rating posters now on the CQC website, this is a gentle reminder not to forget the obligation to display inspection ratings.

Under requirements to display, these posters must be “conspicuous” at premises and websites.

Breaches of this regulation can move directly to prosecution – there’s the big stick – without a warning notice being served.

For split or multi-site providers, the posters must also be displayed “from each and every premises where a regulated activity is being delivered.”

Okay, I know people need to know the ratings, there’d be no point in having them if they were secretly squirreled away from public gaze, but no warning prosecution!

The feedback I’m getting is that for such a minor ‘offence’ – remember this nothing to do with the wellbeing of those receiving care – it’s heavy-handed.

It’s worth noting that providers will be able to defend themselves against such wrongs where they are able to show they took all reasonable steps and acted with all due diligence.

One element of the new enforcement policy does offer a glimmer of hope to providers as the CQC’s aim to take only action that it deems to be “proportionate”.

Granted, we have heard this before and providers on the receiving end of such action are unlikely to agree that the Commission is a proportionate regulator. However, in the light of appeals representations, this assurance should be at least a guide to the central pillar of evidence.

Written by debbielq

April 23, 2015 at 10:17 am

CQC special measures – too heavy handed

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The Care Quality Commission intends that special measures for failing adult social care providers will be introduced in April this year.

An online feedback for the proposals closed on January 30. A draft special measures policy will be issued in this month (February), with the final policy being rolled in March 2015.

Doubtless, the proposals will have a significant impact for all registered providers.

My biggest fear is that it will be all too easy to enter special measures and risk cancellation of registration.

LesterAldridge LLP last month issued a healthcare alter warning providers of what’s to come.

The keys points are – stick with it – I know it’s a long read, but it’s important:

  • Entry point of special measures: When CQC carries out a comprehensive inspection against the five “key questions” (i.e. is the service safe, caring, responsive, effective and well led?) and two of those key questions are rated as Inadequate, CQC states that not only will the entire service be rated as Inadequate but this will also result in immediate entry into the special measures process.
  •  Special measures can be entered even if a comprehensive inspection results in only one of the key questions being rated Inadequate. For example, a service might well have an overall Requires Improvement rating following a comprehensive inspection but have a rating of inadequate against just one of the key questions. Where this happens, CQC will carry out a further focused inspection after six months and if this shows the key question to be still rated Inadequate then special measures will automatically follow.
  •  What are the immediate consequences of special measures? CQC state that it will “signpost providers to potential improvement agency support (where they exist) and monitor progress against their plans. The onus is on the service to resolve the issues of concern”. CQC is silent on what exactly “potential improvement agency support” is. Will CQC for example have an approved list of potential care home consultants, lawyers and other specialists or will this be left to the individual discretion of inspectors?
  •  It is significant that CQC state that when a service is placed into special measures CQC will “liaise with the local authority and the CCG so that they can begin planning for service continuity (if they are not doing so already)”. Such notification will almost certainly result in a contractual embargo which might make improvements that much more difficult to achieve.
  • How long will special measures last? CQC states that the process will usually be limited to a period of six months, following which there will be a further comprehensive inspection. At this stage there will be three possible options: (a) If there are no inadequate ratings remaining, the provider comes out of special measures. (b) If there is sufficient improvement made, the provider “may be given an additional six months to improve”. (c) If there is insufficient improvement, CQC will issue a Notice of Proposal to Cancel Registration.


In the light of these ‘big stick’ approaches, I would like to see some proper dialogue between CQC and associations like mine. There have been talks about a Provider Improvement Agency and clearly local associations need to be at the table if these plans press ahead.

I’m also concerned that there appears to be an awful lot of importance being placed by inspectors on the Mental Capacity Act and Deprivation of Liberty Safeguards. Being quizzed about such legalities immediately sparks panic amongst my members.

Like so many, they too struggle with the bigger issues of the law, but are perfectly capable of operating within the legislation they know. I suppose a parallel can be drawn if I was to ask you about knowledge of the Road Traffic Act. Not knowing every chapter and verse does not stop a person from adhering to the sections of the Act that allows them to drive safely.

I wonder too about the ability for providers to improve once they are in special measures. Inundated with inspectors, from the Local Authority, CCG, infection prevention, pharmacy, Health and Safety etc – all seeking their improvement as priority – is this a good atmosphere for betterment? I think not.

Inspectors who wish to be heavy handed in these circumstances can expect little co-operation. Micro management of someone’s personal investments by a third-party regulator is never going to be easy.

It clearly erodes already battered confidence and would stop providers recovering in a way they feel part of.

A lighter touch all round please . . . and some dialogue would not go amiss.

CQC new regime: The good, the bad and the ugly

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First the good news: The Care Quality Commission has found “many examples of good and outstanding care” using their new inspection criteria.

And now the bad: As the expert-led inspection model rolls out the regulator is discovering wide and “unacceptable” variations in quality.

The tougher approach also discovered that there are not just big differences in the quality of care that people experience from different providers, in different places but also sometimes at different times of the day or day of the week.

The five-question approach – are they safe, are they effective, are they caring, are they responsive to people’s needs and are they well led? – is bound to bring change to existing ratings and perhaps the findings with a sample of NHS trusts will be mirrored in our care and nursing homes.

In an article on the CQC website, the regulatory body says: “We began applying our new inspection approach to NHS trusts in September 2013. We’ve seen some outstanding care – but we’ve also seen examples of care that requires improvement or that’s inadequate. We have found differences in quality from one trust to another, from hospital to hospital within trusts, and between different services within hospitals.”

Some 38 NHS acute trusts were checked by the end of August 2014; nine achieved an overall rating of good, 24 were rated requires improvement and five trusts were rated inadequate.

Stating the obvious, CQC says good leadership drives up quality and safety overall.

But as CQC “calls time” on unacceptable variation in the quality of care and higher the bar for providers, my fear that you get what you pay for remains.

Indeed, I cannot think of a single WMCA member who does not want excellence in their service, but how, tell me how, are we supposed to achieve such glorious goals when there’s such a tight hold on local authority purse strings for bed purchases?

I applaud the sentiment of the Commission to empower consumers to use CQC’s inspection reports and ratings to make decisions on care choice. I also believe in their advice that “providers of poor care need to look at those who are doing it well and learn from them.”

Quality, however, always has a cost – an ugly word, I know – and I’m let pondering once again where the finance will come from to meet the new CQC inspection challenges

Don’t miss out on our audit tool for the new CQC inspections

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The new Care Quality Commission inspection model has been rolled out and we’re all eagerly waiting for the new ratings to be announced.

At the time of writing this, nothing has been announced among our members so we don’t really know how high the bar has been set against the previous criteria.

We are, however, confident that delivering a practical guide which can easily be personalised to any care business, will be an invaluable asset for members in this time of transition.

Simply, we want to make sure everyone is well prepared for the inspection revisions, so West Midlands Care Association has produced a simple, walk-through guide that addresses the five critical pillars of the new regulations.

It’s aim is to provide an easy-access knowledge base of how to safely justify answers CQC is looking for and ensure nothing is missed.

Those using the tool and unable to resolve queries will be able to access support with a phone call.

Under the CQC initiative, inspectors will use professional judgment, objective measures and evidence to assess services against five key questions: Are they safe; are they effective; are they caring; are they responsive to people’s needs; and are they well led.

A standard set of key lines of enquiry (KLOEs) will be used to extract the information to ensure a level playing field on all inspections, a move that has been welcomed by the industry.

We all know the new approach is all about CQC asking the questions that matter to the people who are using the services, but there is a raft of critical procedures and policies that care providers need to be getting right.

Just having the knowledge where to look for supporting information required by CQC and how to present it will make a huge difference to inspection outcomes.

The inspection process aims to provide good information for the Commission for ratings and give the provider a snapshot of how they can improve.

Our CQC Audit Tool looks at ways of avoiding the pitfalls and ensuring nothing is missed in the way CQC expects the management of care to be delivered. It’s simple to use and everything is made as clear as possible

For non-members, the digital document available through email, is £70 and for member £35. Those who have previously purchased audit inspection tools