CQC advice for health and social care providers

The Care Quality Commission (CQC) is the independent regulator of health and social care in England. It ensures health and social care services provide people with safe, effective, compassionate, and high-quality care.

At Hempsons, we have a long history of guiding health and social care providers through their interactions with CQC and its regulatory landscape. Our dedicated team of legal experts is spearheaded by Philippa Doyle, whose invaluable experience within CQC equips her with a profound understanding of the regulator’s inner workings. This experience ensures that our advice and support for providers is realistic and well rounded, fostering a balanced approach to compliance and excellence in care.

Our CQC services

Our CQC solicitors can help with:

  • advice on compliance with CQC regulations and standards
  • guidance on the evidence categories and how they apply to your service
  • assistance with preparing for inspections, including audits, incident learning, and care record reviews
  • support in responding to outcomes, including action plans and follow-up measures
  • support with Factual Accuracy Challenges, Ratings Reviews and complaints

Fundamental standards of care training for care providers

As a provider, registered manager, or member of care staff operating a regulated activity, you must ensure your care and service operates in accordance with the fundamental standards set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. When CQC inspect your service, they will assess all staff’s understanding of these fundamental standards.

We offer bespoke training packages for care providers that focus on embedding a deep understanding of the fundamental standards of care into your staff’s routine practices. If you’re preparing for an inspection or are simply looking to refresh your knowledge, find out more about our training packages and contact us to discuss your requirements.

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    Free CQC resources for providers

    We have put together several useful free legal resources to support health and social care providers in their dealings with the CQC.

    Free legal advice line

    We offer a free legal advice line for care providers. Call or email us for up to 30 minutes’ free preliminary advice on any issue relating to CQC, whether it’s registration, preparing for an inspection, or responding to outcomes.

    Call 01423 724056 quoting ‘social care advice line’ or email socialcare@hempsons.co.uk.

    Webinars and podcasts

    View our upcoming events and register your place. You can watch all of our past webinars for free on our YouTube channel.

    Listen and subscribe to our health and social care podcast here.

    Blogs and articles

    Read our latest legal updates, news, and blogs here.

    Subscribe to our mailing list

    Subscribe to our mailing list to ensure you stay up to date with our CQC updates and receive invitations to our future webinars and other events.

    Frequently asked questions about CQC

    Who needs to register with the CQC?

    Any organisation or individual providing regulated activities, such as treatment, care, or a diagnostic service, must register with the CQC. This includes but is not limited to:

    • Care homes and care home agencies
    • Hospitals, including NHS trusts and private or specialist clinics
    • GP practices, walk in centres, GP-led health centres
    • NHS and private dental practices
    • Ambulance services
    • Community care services such as mental health and rehabilitation units

    What are the fundamental standards of care?

    The fundamental standards of care set by the Care Quality Commission (CQC) are the minimum standards that health and social care providers must meet. They include:

    1. Person-centred care: Care and treatment must be tailored to the individual and meet their needs and preferences
    2. Dignity and respect: Individuals must be treated with dignity and respect at all times during their care and treatment
    3. Consent: Care or treatment must only be provided with the consent of the individual receiving it, or their legally authorized representative
    4. Safety: Individuals must not be exposed to unsafe care or treatment, or to any avoidable risk of harm
    5. Safeguarding from abuse: Individuals must be protected from abuse and improper treatment, including neglect, degrading treatment, unnecessary restraint, and inappropriate limits on freedom
    6. Food and drink: Individuals must have access to enough food and drink to maintain good health while receiving care and treatment
    7. Premises and equipment: The premises and equipment used must be clean, suitable, properly maintained, and used correctly
    8. Complaints: There must be an effective system in place for handling and responding to complaints
    9. Good governance: Providers must have plans in place to meet these standards, with effective governance and systems to monitor the quality and safety of care1.
    10. Staffing: There must be enough suitably qualified, competent, and experienced staff to meet these standards
    11. Fit and proper staff: Providers must only employ individuals who can provide care and treatment appropriate to their role

    How does CQC inspect and monitor services?

    The Single Assessment Framework is CQC’s new inspection regime which was implemented in November 2023. The framework is built around 5 key questions that CQC asks of all health and social care services:

    1. Are they safe?
    2. Are they effective?
    3. Are they caring?
    4. Are they responsive to people’s needs?
    5. Are they well-led?

    These questions are answered through “quality statements”, which replace the previous lines of enquiry. Quality statements are expressed as ‘We’ statements, showing what is needed from the service provider’s perspective. The framework also includes ‘I’ statements from the perspective of people using the services, reflecting their experiences and expectations.

    CQC assessors collect and evaluate evidence to determine if the service meets the regulations and quality statements set out in the framework.

    What are the evidence categories?

    There are six evidence categories:

    • people’s experience of health and care services
    • feedback from staff and leaders
    • feedback from partners
    • observation
    • processes
    • outcomes

    The number of evidence categories considered, and the sources of evidence required depend on:

    • the type or model of service
    • the level of assessment (service, provider, local authority or ICB)
    • whether you’re an existing service or registering a new service

    How can providers prepare for an inspection?

    Providers can prepare for a CQC inspection under the single assessment framework by taking the following steps:

    • Understand the Framework: Familiarise yourself with the new single assessment framework, including the quality statements and evidence categories.
    • Engage with Staff: Keep staff informed of the regulatory changes and ensure they understand the importance of the inspection process. Register for our fundamental standards of care training for managers and staff.
    • Review Internal Processes: Revisit internal processes to align with the framework’s requirements, identifying key pieces of evidence required for each quality statement.
    • Read CQC Guidance: Read the CQC’s provider guidance on the new approach to assessment to understand the expectations and standards.
    • Update Contact Details: Ensure your contact details are up to date, and the right people in your organisation are subscribed to CQC email newsletters to get the latest information.
    • Utilise Resources: Watch webinars and listen to podcasts to gain insights into the new regulatory approach.

    What happens after a CQC inspection?

    CQC gather evidence on and off site to make their assessment. Once the assessment is completed, your service will receive a rating from 1-4:

    4 = exceptional standard

    3 = good standard

    2 = shows shortfalls

    1 = significant shortfalls

    More information on the single assessment framework and how the scores are calculated can be found here.

    How can I challenge a CQC rating?

    The first stage in the challenge process is to engage in the Factual Accuracy Process when you receive your draft report. Timescales are tight – you usually only have 10 working days to respond, so don’t delay in speaking to our team for support and asking CQC for an extension of time to respond.

    Prepare your evidence. This is your one and only opportunity to pick apart what CQC have to say in the draft report. It’s not just about accuracy on numbers, it’s about the report being fair, balanced and proportionate. If you don’t challenge a point, CQC won’t revisit it and the report will be published as drafted.

    Once published, you can still progress and ask for a Ratings Review, but the ability to succeed here is limited. Here’s how the process works:

    • Grounds for Review: The only ground for requesting a review is that the CQC failed to follow its process for making rating decisions.
    • Requesting a Review: A review can be requested using the CQC’s online form, which must be completed by the registered manager, nominated individual, or chief executive. You have a 500 word maximum limit – we can assist in making your submission as concise but as robust as possible.
    • Timeframe: The request must be submitted within 15 working days of the publication of the rating.
    • Review Limitations: The review is not an opportunity for reconsideration of the evidence or judgements made, unless an error in the quality control process is found.
    • Review Process: CQC will first check if the correct quality control processes were followed when awarding the scores and ratings.
    • The review may result in the score or rating going up or down.
    • Outcome: CQC aims to complete all reviews within 50 working days and will make any appropriate changes to the score or ratings on their website as soon as possible.

    This is the final CQC process for challenging a rating. However, if providers are not satisfied with the outcome, they may consider other legal routes such as applying for a judicial review. It’s important to be concise, factual, and polite when submitting your challenge.

    Can I complain to CQC?

    A complaint to CQC can be made at any time up to one year after the incident giving rise to the complaint. Sometimes it might be necessary to complain mid inspection – we have had success in halting inspections mid way where inspection team members’ conduct was inappropriate. It is more usual to present a complaint after the inspection process has been concluded. This might be around the approach of inspectors to your staff, particularly if staff felt upset by the process. It’s a good idea to get everyone to write down their thoughts at the time, when everything is fresh in the mind.

    CQC will not use the complaints process to re-open a report. They will generally not look at a complaint until the report is finalised, but often a complaint goes hand in hand with the Factual Accuracy process

    We can support you in drafting a complaint or prepare it for you to ensure your position is presented in the best possible light. We can also support with progressing a complaint through to the Ombudsman if you are not happy with CQC’s response.

    We have seen apologies from CQC around inspection team members’ conduct, and re-training ordered – if you don’t complain about the conduct of the CQC team – who else will? People often ask who regulates the regulator – you do!

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