None of us want to fail, especially after preparing for a CQC inspection. It is not something any of us set out to achieve, but it happens.
It only takes one thing to happen during an inspection for a provider to be on the receiving end of an Inadequate or Requires Improvement rating. In this week’s blog post, I look at the process and impact of failing a CQC inspection.
How will you be told that you failed a CQC inspection?
It is likely that at the end of your inspection, the inspector will debrief you and let you know that they have concerns. Try not to panic – remain calm and try to establish what concerns they have 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 into place to address these concerns before the report is sent to you.
What happens at the end of a failed CQC inspection?
Your report or outcome will be emailed to the nominated individual and the Registered Manager, and what happens next depends on the outcome – your rating.
It is extremely likely that the regulator will request an action plan detailing what proposals you have and what actions you are taking to meet the issues identified. Providers are then expected to inform the regulator in writing once they have completed these actions.
What happens if you get a Requires Improvement rating
Where a service is repeatedly rated as Requires Improvement, the CQC will require an improvement action plan from the provider. This should provide details on what improvements will be made to improve the service’s quality, safety, and rating, and will need to be completed within 28 days. This will be requested under Regulation 17(3) Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
It is also likely that they will write to the provider to inform them that any subsequent ratings of Requires Improvement may constitute a breach of Regulation 17 (good governance) and suggest sources of help for the provider to seek improvement.
In some instances, the regulator may request a meeting with the provider, registered manager and commissioner to discuss concerns, improvements needed, and support that may be available. After the meeting, they will send a letter to the provider that confirms the points that were agreed during the meeting, and this may include requesting the completion of an improvement action plan.
Where the CQC have identified concerns, or there has been a breach of the regulations, they will decide what action is appropriate to take. Inspectors follow the enforcement handbook, in conjunction with the enforcement policy and decision tree, in the decision-making process when considering what enforcement action is needed. It could be one of the following:
Issue a requiring improvement enforcement action
- Requirement Notices (formerly known as ‘compliance actions’)
- Warning Notices. You can read more here.
- Section 29A Warning Notices (NHS Trusts only)
Issue a forcing improvement
- Civil enforcement powers
- Imposing, varying or removing conditions of registration
- Suspending registration
- Cancelling registration
- Urgent procedures
Put you into special measures
- Time limited approach ensures inadequate care is not allowed to continue.
- Coordination with other oversight bodies
Other enforcement actions could be to issue a caution, issue a penalty notice, or prosecute.
What to do if your care service is rated Inadequate
If a care service is rated Inadequate for one of the five key questions, the CQC will inspect it again within six months of the report being published. If the service remains Inadequate in any key question at the second inspection, it will enter special measures.
Services rated as Inadequate overall will go straight into special measures. The CQC’s special measures framework is designed to ensure a timely and coordinated response where they judge the standard of care to be inadequate. Its purpose is to:
- Ensure that providers found to be providing inadequate care significantly improve.
- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
- Provide a clear timeframe within which providers must improve the quality of care they provide, or they will seek to take further action, for example to cancel their registration.
Six months is plenty of time to improve and meet the actions required. After this time, the inspector will return and re-inspect to check on the areas of concern and to make sure there has been improvements.
If the inspector feels sufficient progress has been made, they will remove the service from special measures. However, there are times when actions have not been addressed or the inspector is still not satisfied. At this stage, the service would be deemed as remaining inadequate and placed under special measures.
It is important to note that if sufficient progress has not been made when they re-inspect and there are inadequate ratings for any key questions, they will begin to take action to prevent the service from operating – either by proposing to cancel the service’s registration, or to vary the terms of their registration.
It is likely at this stage that the inspector will then closely monitor the service until it either closes, or substantial and rapid improvements are made. You can read more about the CQC’s special measures here.
What is the impact of a failed CQC inspection?
Not only does the service risk enforcement action, but there are other impacts of a failed CQC inspection.
You may lose trust from the people you support, and their families and friends. Some people may give notice to use your service, you may see a reduction in referrals, partnerships may be cancelled, and you may also receive bad publicity in the media, both print and online.
In addition to potentially seeing a reduction in referrals, people may give notice on their care. However, if the regulator places an embargo on the service, which means no new care can be delivered, this could also impact your financial income.
There may be fines from the regulator and the company may need to pay for legal costs – and all of this could put the business at financial risk. It is important to monitor income and expenditure during this time to ensure financial viability.
Lack of staff morale and retention
It is likely you will lose some of your staff. At the end of the day, no one wants to be associated with a failing service and some staff may jump ship.
It is important to ensure effective communication with your team and encourage them to join you on your journey to overcome the shortcomings that have been identified by the inspector.
Now that you know about the process, you can also look into helpful steps to take if you happen to fail a CQC inspection.
It is important to remember that the CQC is always on the side of the person receiving care. They do not want to shut down services, and they know the impact this would have on those using care services and those working in them – however, they do need to take appropriate action where needed to ensure quality care is being delivered.
For further information, the CQC has published a table showing the action they will take if they find a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This can be viewed here.
Log my Care has helped hundreds of providers like you ace inspections, and have seen customers go from Good to Outstanding. If you would like to discuss how we can help you better evidence care, you can get in touch with our team of digital care management experts for more information.