Change is an uncertain thing by design. We grow and improve through change, but that does not mean we always know exactly how. The Care Quality Commission (CQC) is in a transitional period. A period whose challenges reverberate across the social care sector and beyond, raising hopes, but also questions. We recently hosted a CQC webinar where Chris Day, CQC’s Director of Engagement, answered the most prominent questions submitted by Nourish Care users. As put to him by our Director of Customer Success, Ruth Norman.  

We learned of an organisation adapting to the needs of its community and building for the future. An organisation with enough self-awareness to recognise the mistakes it’s made, and the vision to correct them in the continuing pursuit of their person-centred, technology-enabled, ambitions.  

“The next steps of this journey for us is very much working with you so you and our colleagues who inspect have a really clear and collective understanding of what good looks like.” – Chris Day, Director of Engagement, CQC 

The CQC webinar was exclusively for Nourish users. We selected some of Chris Day’s most prominent insights below.  

If you are interested in joining Nourish and working with regulators, commissioners and communities to build the future of social care together, book a demo today. 

At the heart of the new inspection framework is a realisation. The CQC felt they were too focused on processes, not outcomes. The new approach focuses on outcomes, on the voice of the people and using the service and the staff supporting them. ‘I’ statements are designed to reflect what an individual expects from their service, and the ‘We’ statements illustrate how a service responds to those expectations. The CQC are eager to connect the dots between services with their new assessment framework. However, they acknowledge the work needed to refine how ratings translate across the 18 sectors they regulate and want to work with providers to address this. 

Chris highlighted the importance of re-establishing the link between providers and their local inspectors. He admitted the CQC overlooked the importance of these relationships when establishing the single assessment framework. The quality of these local relationships is crucial for building trust. They will launch a series of pilot programmes for local inspector hubs in October 2024 and will share further information for attendees through Nourish. The CQC want to give people the ability to talk to their inspectors without an inspection. To know and understand their inspectors through continued engagement. To build trust at a local level and share best practise.   

“A manifestation of care planning reality,” said Chris.  The biggest delineator of ratings comes down to the extent providers understand the issues they face. Including those outside their control, and crucially, what they are doing to address them. They want providers to show the relationship between the care planning, the training, the way observations are taken and the way support is given. It is important to give your team the confidence to connect data and information with people’s lived experiences. And the comprehension to explain those connections to inspectors. It’s not about providing a wealth of raw data. Care plans are more than a box-ticking exercise. How you tell the narrative story matters.  

Specifically, during our CQC webinar, Chris advised providers to use ‘edge’ or ‘outlier’ cases. Rather than a uniform overview of similar care plans. The new framework focuses on how a care plan reflects how you deliver care. How the person utilising support and their family experiences the care and how the specifics of your service’s context shape the care. Show the journey.  

First and foremost, it is important to understand the portal has several different functions. Chris spoke about the registration, notification and assessment functions during our CQC webinar. Fundamentally, the technology behind the portal isn’t working in the way they wanted. While notifications are functioning and will continue to do so, registration and factual accuracy checks are not. The CQC recognise how important it is to keep these services running, and so will be reverting to the pre-portal approach for both. Those who have completed or nearly completed their registration through the portal will not need to redo it in the old fashion, while those earlier in the process will be supported to switch methods. They are building out their registration team to expedite this process. Further information will be shared with Nourish users shortly.  

“I think we’ve let you down in terms of the time it takes to process registrations and take forward inspections,” said Chris. Addressing this swiftly is the key motivator for moving back to the older systems. They will be able to increase the number of registrations and inspections they conduct by returning to systems they are familiar with.  

The CQC looks to divide registrations between complex and ‘transactional’ needs, to help resolve simpler registration requests quickly. They will still use the quality statements for inspections, rather than key lines of enquiry, with the older process. “We know we had higher productivity pre covid with the inspection approach we took,” explained Chris. 

 The priority of inspections going forward for the CQC is ‘to form a view of the quality that someone who is going to use that service can expect’. They are currently undertaking modelling for inspection timelines and rates and are expecting to finish the modelling in November. Once the modelling is completed the CQC will share it with Nourish and providers. 

Naturally there was apprehension in our chat about the order of urgency of inspections. While the priority will be on addressing known harm, uninspected newly registered services and services ranked poorly who have had time to improve, Chris acknowledges the need to focus on inspections that show the positive changes providers have implemented. They are growing teams and their use of clinical experts to increase their inspection capacity. 

For those uncertain about how long this will take it is important to remember, when key lines of enquiry were first brought in, the CQC inspected every service in their charge over three years.  

Currently there are a range of experience and comfort levels with care technology in their workforce. A major part of inspector training is to ensure they understand the technology available to providers. Something they are eager to work with Nourish on developing.  Chris acknowledges the significant role technology can play in helping the CQC establish a ‘common view of quality in adult social care’.  

Data is a huge opportunity for care. Normally data is centred on the NHS. Access to real time information increases the understanding of care and service performance. Which in turn drives positive change. Bringing commonality to how data defines quality care is no easy feat, and there is a journey still to go on. However, Chris knows from previous work that data information is often at the heart of positive changes organisations have made and it has an important part to play in shaping the future of health and care. Including conversations about the long-term funding of health and care. 

As the hour drew to a close we posed a selection of questions from the session to Chris. Here is a brief overview of his responses. 

The CQC plans to review their inspection ratings in the near future. Their goal is always to triangulate data to get a full picture of the quality of a service. The primary goal being to establish these ratings as a more narrative description of the care you can inspect, rather than simply a ‘score’. 

The provider ‘handbook’ for inspections was recently approved. Over the next four to eight weeks the CQC will engage with providers to develop it. 

Understanding risk is crucial to justifying it. With specific regard to concerns over how the CQC will review potentially risky activities that increase quality of life for people drawing on support. This reiterates the need to rebuild trust between providers and inspectors Chris discussed earlier in the CQC webinar.  

Their ambition for Local Authority inspections to relate to provider inspections. The CQC are committed to providing further context for provider inspections by better understanding the worlds in which they operate.  

“That’s my ambition,” concluded Chris. “It’s not where we are at the moment, but I’d really like to do that. I’m happy to come back and talk about the Local Authority stuff moving forward.” 

The CQC are building for the future. But in order to do that they know they have to rebuild trust with the adult social care sector. There remains a great deal of work ahead of all of us to achieve the ambitions of the regulator and providers alike. Ultimately, we are all unified in our vision of better, more person-centred, care.  

Nourish are committed to working with everyone involved in the process, so we can change with confidence and drive better outcomes as a result. Join Nourish today to avail of future CQC webinars, integrated innovations and community led care technology.

Over the past few years we’ve formed a close working relationship with former CQC inspector Anne Weston. Anne is now is part of RHW Care Consults, a specialist team designed to help care providers with their regulatory commitments. Her understanding of how the regulatory bodies aim to operate, combined with her vast knowledge of the care industry are really second to none. This week, we spoke to Anne and challenged her to come up with the 5 key areas she felt that care providers’ care services and plans needed to really get to grips with, in order to perform well in their inspections.

Your safeguarding systems need to be reviewed regularly. This will ensure that those using your service are protected from any bullying, harassment, avoidable harm or potential abuse and may include DOLS applications.

Ensuring that you have a safe environment to operate within is critical. This means you need to ensure that you have everything from equipment to risk assessments on premises and specialised equipment in place where required, in order to provide care safely.

You need to make sure that you have robust infection prevention and control. Both of these need to be compliant with the Code of Practice and PPE monitoring.

Safe management of medication including: audits, ensuring behaviour isn’t controlled by inappropriate medicine usage, competency assessments, reconciliation when transferring and monitoring visits from Pharmacies.

Staffing levels reviewed based on those in your care’s needs to ensure enough competent staff are available who have the right skills to provide effective care.

Active Dignity Champions, maintaining a dignity diary which recognising good practice and supporting continuous improvement. Ensure the “10 Dignity Dos” and factors are always promoted. Do you have dignity themed supervisions and meetings? If so do they use the 7 common core principles to underpin their content?

Person-centred care plans need to be regularly reviewed. If they don’t show personal history, expressed preferences and how needs are met they are unlikely to pass muster. Staff also need to understand and respond to people’s diverse needs in a caring and compassionate way.

Use values based interview to recruit staff who are genuinely caring, compassionate and empowering.

People’s preferences in their end of life care are clear in care plans.

Is your training and development programme underpinned by the Care Certificate and the 6 Cs, with training in equality, diversity, inclusion and human rights? If not, then you should consider updating its content to show your adherence to current best practice.

People involved and contribute with assessment and care planning processes. People are listened to and have their diverse circumstances respected. People supported to make choices and have control of their lives. Changes in people’s needs recognised and action swift.

Clear complaints and comments policy and procedure. Respond to complaints and concerns promptly, ensuring that effective resolutions are sought.

Involvement with the local community promoting inclusion. People using your service should be supported to maintain community links.

Staff are creative in fostering support for people to live as full a life as possible, this includes ensuring that those in your care are helped to achieve as meaningful a set of activities as possible

Structured staff handovers to promote effective teamwork so that people receive a consistently responsive care services.

Nutritious meals and snacks supporting a balanced diet, according to people’s preferences. Ensuring a positive mealtime experience with meals appropriate to meet the needs of those in your care.

Ensure those who you care for have access to relevant healthcare services and support. Accompanying people to healthcare appointments, so that they experience consistent, planned co-ordinated care and support.

Do your working practices account for the importance of consent to care, treatment and support and consideration of mental capacity?

Training and development programme which enables all staff to have the relevant qualifications, knowledge, skills, and behaviours to effectively carry out their role.

A staff supervision programme, used to develop and motivate staff and review their practice needs to be implemented and maintained.

Registered Manager actively promoting a supportive and open person-centred culture. Leads with values that include compassion, dignity, independence, equality and safety which staff understand and practice.

Quality assurance systems with the aim of continuous improvement. Learning lessons through any safeguarding and complaint outcomes. Creation of action plans where improvements are needed.

Management links with external organisations to foster good practice. Working practices follow recognised good practice methodologies which are then implemented into the care services you provide.

Legal obligations from CQC or other external organisations are achieved. This includes regular review of policies and procedures; submission of Notifications to CQC; Nurses working in accordance with NMC guidelines and reporting to Health Protection Agency (HPA), Clinical Commissioning Group (CCG) and RIDDOR.

Designated Champions within the service who support staff to ensure people experience good health and social care outcomes leading to quality of life e.g. Dignity Champion; Moving and Handling Champion; Infection Prevention and Control Lead; Dementia Lead; Communication Champion; Medication Lead.

To find out more about how Nourish can help with your care planning and management, then please do feel free to get in touch at caring@nourishcare.co.uk or give us a call. We work closely with a whole range of care providers, from residential and nursing settings to domiciliary care providers right the way through to large national groups. This means we’re expertly placed to offer practical help and services to support the quality of care you provide.