The moment many of us dread: either verbally or physically receiving your draft inspection report, only to open it and see that you have been given a requires improvement or inadequate rating. I have never been in this position myself, but I have been on the end of the phone to managers several times and it never gets any easier.
If you’re wondering what to do when you fail a CQC inspection, this week’s blog post dives into 13 steps you can take to fix your CQC rating, and how to contest an outcome you feel is inaccurate.
1. Compose yourself
First things first, regardless of whether you are verbally told or see it in the draft report, your emotions are going to be all over the place. From experience of speaking to other managers, you may experience a range of emotions, including guilt, upset, feelings of failure, anxiety, worry, anger or resentment. In some cases, you may even feel relief (especially if you know the service isn’t up to the standard it should be) which can be a blessing in disguise and the first step to action being taken.
Regardless of your emotions, it is important to compose yourself. Take some time to sit down, take in what you have been told and think about how you will act/respond next. If you are being told verbally, try to get as much information as you can. You will have to wait for your report for the full details but if you have some insight, you can begin putting steps in place to address these concerns.
2. Tell the nominated individual and your senior team
Before you do anything else, you should inform your senior level team and the nominated individual. Be open and transparent with the feedback the regulator has given you and set a meeting so you can draft a plan of action as a team.
This isn’t always going to be easy, and I have spoken to managers in the past who have heightened anxiety that they are going to lose their jobs. Be brave and be transparent. It will only come out in the end, so you’re better off doing it and guiding the conversation than leaving it, having no control and then are more likely to lose your job for not being open and honest.
3. Seek support for your own health
Failed inspections and poor outcomes can take its toll on you and that is understandable. Make sure you seek external support from your GP or other services if it is impacting your mental or physical health.
Be honest with your employer about how it has impacted you, so that they, too, can support you.
4. Stay compliant with regulations
Make sure you comply with any requirements or recommendations from the regulator to prevent any further action being taken.
With the new single assessment framework rolling out, Log my Care have compiled a few helpful resources to ensure CQC compliance and get you started on the right foot.
5. Draft a plan
The sooner you can draft a plan of action, the better. You should consider negative media attention and communication plans for informing staff, the people you support, families and friends. You should also think about how you will resolve the issues highlighted by the inspection report, what support you need and the timescales.
Typically, reports are published on the CQC website within 50 days of the most recent inspection, so make sure you have the plan completed in time for it being in the public domain.
6. Manage media attention
It is likely that a poor inspection report will generate media attention, which could be local or national. With the use of social media, a news article can quickly spread, raising further awareness.
You should plan for what happens if reporters come to your service, so make sure you have a media policy and a statement confirming what you will say. Be prepared for negative messages on social media, negative or prank phone calls or letters in the post. Your plan should also cover how you will protect your staff and the people you support, should they be approached outside the workplace.
You will need to communicate the outcome of the inspection to your staff team, the people you support and their families, friends and representatives. This will not be easy, so ensure you are prepared. You need to be honest, explain where you fell short during the inspection and reassure people on the actions you are going to take. This should be done in a timely manner, ideally on the same day. Speak to one group after another to prevent gossiping or misinformation spreading.
Give all parties a chance to ask questions and raise their concerns. Remember to have empathy – imagine how you would react if you were being told your relatives’ care service was underperforming. Their heightened emotions and questions are understandable, but it is your job to reassure them.
Think about what methods of effective communication you can put in place to ensure it is effective, and make sure you utilise these regularly to ensure people feel informed and reassured.
8. Display the rating
By law, you must display the ratings of your inspection, so make sure you do not fall foul of doing this.
Update your website and any displays within the service or office. The regulators’ expectation is that you display your updated rating within 21 days of receiving the outcome.
9. Create an action plan
You need to have an action plan of how you will address the underperforming areas of your service and to do this you should:
- Fully understand why the inspector rated you as they did.
- Re-read the inspection report and understand the areas of improvement.
- Consider any training or development needs for your staff team.
- Review policies and procedures to ensure they are accurate and up to date.
- Seek feedback from your staff team, the people you support and their family and friends.
- Ensure you have a feedback loop so you can continuously receive feedback, provide updates and ensure effective communication.
The regulator will want you to respond to any areas of concern identified, so ensure your action plan addresses this and how you are going to improve. The action plan should be detailed, outlining the specific steps the organisation is taking, who is responsible for which action, as well as timescales.
10. Seek external support
We are not miracle workers, and we can only do what we can with the knowledge and skillset we have. It’s important to acknowledge when there are things you do not know or where you need external or additional support.
Social care consultancies or independent consultants can help create action plans, support you through change and help guide you through the period. They can provide tools, paperwork and information to help address the actions highlighted in the report.
A useful benefit about having a consultant support you is that they can share experiences from other providers of what they have in place or have done to appease the inspectorate.
11. Contingency planning
You should anticipate any potential challenges that may arise during these plans and develop contingency plans to address any obstacles that may arise.
Having a clear goal-setting strategy can help you see the bigger picture, understand where you might see some challenges, and track your progress.
12. Ongoing monitoring
The CQC is likely to give you six months to make changes, which is plenty of time to improve the service. However, during this time it’s important that you continuously monitor the action plan and progress. It’s likely you will need to adjust your plans based on feedback and ideas, so be open-minded.
13. Contesting your report
It’s worth noting that inspectors make mistakes, and the outcome of an inspection may be harsher than needed. As a provider, you are within your rights to contest an outcome.
Before a report is published
You will receive a copy of the draft report (which will include your ratings) and at this stage, you are invited to provide feedback on the report’s factual accuracy. You can challenge the accuracy and completeness of the evidence on which the ratings are based.
Any factual accuracy comments that the regulator accepts may result in a change to one or more of your ratings. It’s important to note that you only have 10 working days to review draft reports for factual accuracy and submit your comments.
If the regulator serves a warning notice, they will give you the opportunity to contest about the matters in the notice. The content of the notice will be backed up by evidence about the breach which can also be found in the inspection report. As with the factual accuracy check, any notices that are contested and upheld may result in relevant ratings also being amended.
After a report is published
Providers can ask for a review of ratings after the report has been published, however, the only grounds for requesting a review are that the inspector did not follow the process for making ratings decisions and aggregating them. Unfortunately, you cannot request a review solely on the basis that you disagree with the judgements made by the inspector.
If you think that the CQC have not followed the published process properly, and you want to request a review of one or more of your ratings, you must complete the request for review webform within 15 working days of the report being published. There will be instructions on how to submit a rating review in the cover letter they send you with your final report.
In the request for review form, you must say which rating(s) you want to be reviewed and all relevant grounds. Where the CQC do not uphold a request for review, you cannot submit a subsequent review of the ratings from the same inspection report.
What happens during the review?
The CQC will assess whether the request for a review falls within the permitted grounds and will update the providers profile on their website that a rating review has been requested.
The request for review will be dealt with by CQC staff who were not involved in the original inspection and will have access to an independent reviewer.
Once they have reached their final decision, they will send you the outcome of the review. Where a rating is changed, the report and ratings will be updated on their website. You should be aware that during the review, ratings can go down as well as up.
The review process is the final CQC process for challenging a rating.
I hope this has helped you prepare for what to do if you have, or should ever, receive an inadequate or requires improvement rating, as well as provide you with some insight into how to contest an inspection outcome.
Remember, take your time, seek support if needed and reach out to other managers for ideas, moral support and guidance. Don’t deal with this alone.
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