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Changing the way CQC regulates, inspects and monitors care

Adult social careMay 2014

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Our purpose and role

Our purposeWe make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve

Our roleWe monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care

We will be a strong, independent and expert inspectorate that is always on the side of people who use services

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Adult social care visionThe Mum Test

Is it safe?

Is it caring?

Is iteffective?

Is it responsive to people’s needs?

Is itwell-led?

Is it good enough for my Mum?

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Our new approach

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Making the Mum Test Real

Communication

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What will be different?

Now

Future

Risk based model More targeted

Caseloads More manageable

Making judgements On the 5 key questions

Enforcement when needed

Commitment to taking firm action

Publishing our findings

Clearer reports

Ongoing monitoring Better information

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Timetable

Co-production and development to shape consultation proposals

Oct 2013 – March 2014

Consultation on regulatory approach, ratings and guidance

April 2014

Wave 1 pilot inspectionsApril – May 2014

Evaluation; guidance and standards refined.

July – Sept 2014

Wave 2 pilot inspections and initial ratings of some services

June 2014

Oct 2014

New approach fully implemented and indicative ratings confirmed

March 2016

Every adult social care service rated

4 June:Consultation

closes

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Inspection principles

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What will be different?

Intelligent monitoring

Provider information return

Questionnaires – community services

Sharing information with external partners

Inspections

6 months – 2 years

Tailored inspection teams

Increased use of experts

Experts by Experience

Specialist Advisors

Our key questions and key lines of enquiry

We will no longer focus solely on whether providers are compliant or non-compliant with regulations

Our focus is on the five key questions about services:

Is it safe?

Is it effective?

Is it caring?

Is it responsive?

Is it well-led?

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Principles for our key lines of enquiry

For each of the five key questions there are mandatory key lines of enquiry

There will be additional key lines of enquiry based on:

An inspector’s knowledge of the service

Information available

The inspectors professional judgement

They support consistency of what we examine under the five key questions and focus on those areas that matter most

Key lines of enquiry are supported by guidance on the ‘key things to consider’ as part of the assessment – these are called prompts

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Safe

By safe, we mean that people are protected from abuse and avoidable harm.

In adult social care, this means that people are supported to make choices and take risks and are protected from physical, psychological or emotional harm; abuse, discrimination and neglect.

Key line of enquiry example:How are people protected from bullying, harassment, avoidable harm, abuse and breaches of their human rights?

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Effective

By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.

In adult social care, this means that people are supported to live their lives in the way they choose and experience the best possible health and quality of life outcomes.

Key line of enquiry example: How are people’s needs and choices for care, treatment and support met?

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Caring

By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect.

In adult social care, this means that people, their families and carers experience care that is empowering and provided by staff who treat people with dignity, respect and compassion.

Key line of enquiry example: How are positive, caring relationships developed with people using the service?

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Responsive

By responsive, we mean that services are organised so that they meet people’s needs.

In adult social care, this means that people get the care they need, are listened to and have their rights and diverse circumstances respected.

Key line of enquiry example: How do people receive personalised care that is responsive to their needs?

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Well-led

By well-led, we mean that the leadership, management and governance of the organisation assure the delivery of high-quality care, supports learning and innovation, and promotes an open and fair culture.

In adult social care, this means that people get the care they need, are listened to and have their rights and diverse circumstances respected.

Key line of enquiry example: How does the service promote a positive culture that is person centred, open, inclusive and empowering?

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Q&A

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Ratings

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Four point scale

High level characteristics of each rating level

Innovative, creative, constantly striving to improve, open and transparent

Consistent level of service people have a right to expect, robust arrangements in place for when things do go wrong

May have elements of good practice but inconsistent, potential or actual risk, inconsistent responses when things go wrong

Severe harm has or is likely to occur, shortfalls in practice, ineffective or no action taken to put things right or improve

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How key lines of enquiry and evidence build towards ratings

  

Intelligent monitoring and local information

Pre-inspection information gathering 

On-site inspection

Speak to staff and

people using the

service

 

Key lines of enquiry

(mandatoryplus

additional KLOEs

identified from

information held)

Gather and record evidence from all

sources

Define the questions to

answer

Write report and publish alongside

ratings 

Outstanding

Good

Requires improvement

Inadequate

 

 

 

 Apply consistent principles,

build ratings from the recorded evidence

Make judgements

and build ratings

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How do we decide a rating?

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To what do we give ratings?

Services will be rated at two levels:

level one - we will use our rating methodology and professional judgement to produce separate ratings for each of the five key questions

level two - we will aggregate these separate ratings up to an overall location rating using ‘ratings principles’

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Principles

The five key questions contribute equally to the overall location rating. Overall ratings are produced using the following principles:

•If two or more of the key questions are rated ‘inadequate’, then the overall rating will normally be ‘inadequate’

•If one of the key questions is rated ‘inadequate’, then the overall rating will normally be ‘requires improvement’

•If two or more of the key questions are rated ‘requires improvement’, then the overall rating will normally be ‘requires improvement’

•At least two of the five key questions would normally need to be rated ‘outstanding’ before an overall rating of ‘outstanding’ can be awarded

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Rating limiters

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Q&A

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Other ways to share your views

Consultation: 9 April to 4 June 2014

Get involved:

Web form at www.cqc.org.uk

Twitter @CareQualityComm

Email CQCchanges.tellus@cqc.org.uk

Provider online community: join at www.cqc.org.uk

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www.cqc.org.ukThank you