All CQC registered providers, from the biggest NHS foundation trust down to the smallest care home, GPs and dentists alike, are required to adhere to the CQC fundamental standards of care.

Set out in Section 2 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, each and every regulation must be followed but Regulation 12 can have the biggest consequences, for both the people you support, and you as a provider, if you get it wrong.

Regulation 12(1) Care and treatment must be provided in a safe way for services users

Of course it must. It goes without saying. It’s why you work in a caring industry. But what does “provided in a safe way” actually mean and what are CQC looking for?

The regs set out nine requirements that a provider must do and again, note the use of the word “must” – there’s no discretion here, you can’t not do something because it doesn’t work well in your service or you’ve never done it before – going back to the precise wording of the regs, and making sure you can deliver against that wording, is what will help take your service up a notch with CQC and enhance the lives of the people you support along the way.

Regulation 12(2) sets out the things which a registered person must do to comply with that paragraph

1. assessing the risks to the health and safety of service users of receiving the care and treatment – make sure your care plans and risk assessments are up to date
2. doing all that is reasonably practicable to mitigate any such risk – if there is a risk of falls, show how your care plans and risk assessments mitigate that risk and how staff are trained and aware
3. ensuring persons providing care or treatment have the necessary competence, skills and experience to do so safely – link to your recruitment and training plans – ensure staff are up to date with mandatory training – ensure references are followed up for new staff, that inductions are completed and supervisions carried out
4. ensuring premises are safe for use and used in a safe way – daily/weekly visual checks and actioning loose treads on a stairway, splinters on a handrail, broken toilet seats
5. ensuring equipment used for providing care and treatment is safe for use and used in a safe way – even if provided by the LA direct to a patient, your staff still need to make sure it’s fit for purpose – is the inspection/safety certificate in date? Do a visual check before use each time (and document that!) make sure all staff are trained – eg hoists can differ – make sure new staff are trained on your hoists in the right way
6. where equipment or medicines are supplied by you, make sure there are sufficient quantities to ensure the safety of the service user and meet their needs – eg PPE, creams – don’t let stocks run out, ensure timely re-ordering
7. the proper and safe management of medicines – I can’t stress enough how important it is to ensure MAR charts are properly completed, audited and any gaps identified and rectified
8. assessing the risk and preventing, detecting and controlling the spread of infections, including those that are health care associated – ensure adequate PPE, ensure staff are trained, ensure staff use it. Encourage staff and service users to whistle blow on anyone who doesn’t and take immediate action
9. where responsibility for care is shared with, or transferred to, other persons working with such other persons, service users and other appropriate persons to ensure that timely  care planning takes place to ensure the health, safety and welfare of the service users – be very clear on who is responsible for what, ensure information is shared eg between GP, district nurses, care team – lack of communication is the biggest risk to provider, staff and service user in a shared care arrangement

Good record keeping, documentation, evidence and auditing are all at the heart of safe care and treatment. Know what your client needs, and ensure you deliver against it, and can evidence that you’ve delivered against it, every time.

Everything set out above should be second nature in any service, but where providers often fall down is their risk assessments and being in a position to demonstrate that you know your service users as well as you say you do, and that you’re delivering the care they are entitled to.

What happens if it goes wrong?

It’s not always about getting it wrong, as opposed to how you react to the situation. Any service involving people will sometimes have mishaps – even the most safely supported person can slip in the shower or a GP referral can be over looked. The key is identifying the issue and responding to it in a timely way. CQC look to see how responsive you as a provider are to a situation. Did your systems and processes pick up the missed medication? Did your staff spot the missed medication and call the GP to check the impact on the patient? Or did you do nothing and gloss over it because the patient looks fine?

Sometimes things can go really wrong, and someone might die. Was that death inevitable, or did your service miss something? Did your systems and processes allow someone to fall through the gaps? Did you think one service was doing something in a shared care arrangement and they thought you were doing it?

CQC can and do prosecute for failure to deliver safe care and treatment. There will undoubtedly be an inquest. The police will investigate. They might not prosecute but CQC will pick up where the police left off and will often take action, even if the police don’t. It can take up to three years to get to that point and fines can be significant. Prosecution takes place in the magistrates court and fines reflect the size and turnover of your company. They are designed to be painful but not put you out of business, but we see weekly reports of care homes fines anywhere from £3,000 to £30,000 and more for avoidable deaths of care home residents. The NHS has seen fines much larger, where a patient in a mental health unit has managed to gain access to a roof and take their own life.

Don’t be scared, be aware. Safe care and treatment benefits anyone.

For further advice and guidance on the Fundamental Standards get in touch with Philippa Doyle, Hempsons, on 01423 724028 p.doyle@hempsons.co.uk or visit our website.

This article first appeared in the Care Home Management July/August 2022 edition.