old lady stares kindly cqc ratings

A comprehensive overview of the Care Quality Commission and the home care sector

What is the CQC?

The Care Quality Commission (CQC) is the independent regulator of health and social care in England. Its job is to make sure health and social care services provide people with safe, effective, compassionate, high-quality care and to encourage care services to improve. CQC ratings are used to measure quality across services.

What does the CQC do?

  • Registers care providers
  • Monitors, inspects and rates services
  • Takes action to protect people who use services
  • Speaks with an independent voice, publishing its views on major quality issues in health and social care

Through its work it:

  • Protects the rights of vulnerable people, including those restricted under the Mental Health Act
  • Listens to and acts on service users’ experiences
  • Involves the public and people who receive care
  • Works with other organisations and public groups

How does the CQC inspect care providers?

The CQC conducts inspections which are an important part of regulating health and social care providers in England. This usually consists of site visits, which allows it to observe care and to look at people’s records to see how their needs are managed.

The CQC carry out regular checks on health and social care services – these are called comprehensive inspections.

It also carries out focused inspections. These are smaller in scale than comprehensive inspections, although they follow a similar process.

Focused inspections are carried out:

  • To look at something we’re concerned about, which might have been raised during a comprehensive inspection or through our monitoring work.
  • If there is a change in a care provider’s circumstances. This might mean they’ve been involved in a takeover, a merger or an acquisition.

Depending on the type of inspection, providers have up to now been asked about all or some of the CQC’s key lines of enquiry. These will soon be replaced by quality statements.

The CQC has five key lines of enquiry to establish whether care is:

  • safe
  • effective
  • caring
  • responsive to people’s needs
  • well-led

What do CQC inspections involve?

During inspections, the CQC asks people about their experiences of care, talk to care staff, and check that the right systems and processes are in place.

Inspectors work to establish whether the standards are being met or not, and publish reports of findings on its website.

The CQC also requires providers to complete the provider information return (PIR) which is a snapshot overview that details any changes made and evidence to show that the service is safe, effective, caring, responsive and well-led.

In between inspections, the CQC monitors all the information from the public, care staff, care services and other organisations.

A transitional approach in response to Covid-19

As the risks from the coronavirus pandemic change, the CQC has altered its Emergency Support Framework to a Transitional Monitoring Approach (TMA) targeting specific areas under the
key lines of enquiry. This focuses on safety, how effectively a service is led and how easily people can access the service.

Broadly, the TMA consists of CQC gathering information about a service, making a monitoring call, and following the call, sending a monitoring summary record.

And while it’s not an inspection, it will help the CQC to decide whether further regulatory action is needed. The focus of the TMA is on monitoring risk and is used to decide whether further regulatory action needs to be taken, for example, an inspection.

What is the future of CQC inspections?

From September 2020, the CQC has announced it would be piloting virtual inspections with willing domiciliary care providers. Gathering evidence through the use of technology, such as videoconferencing and care management systems.

The CQC has outlined full details of its proposed new digital approach in its strategy document – ‘The world of health and social care is changing. So are we.’

More recently the CQC has provided updated details about its response to the consultation on flexible and responsive regulation – which indicated a high level of support for reviewing and updating ratings more flexibly.

How does the CQC rate care providers?

In most cases, inspection reports include a rating. These can help users compare services and make choices about care.

There are four ratings – and the CQC will give a rating for each key question as well as an overall rating for the service.

What are CQC ratings?

  • Outstanding – The service is performing exceptionally well. staff are delivering an exceptional and innovative service with a culture that considers imaginative ways to manage risk and increase people’s opportunities. Careworkers are supported to find creative ways to support people to live a full life and can build strong relationships with service users and their families. 
  • Good – The service is performing well and meeting expectations by delivering an effective and consistent level of care. The provider has demonstrated a robust quality assurance system, which shows a focus on quality, lessons being learned and staff being held to account.
  • Requires improvement – The service is not performing as well as it should and has been told how it must improve. Quality of care is not consistently safe, and care isn’t provided in line with the latest legislation, guidelines and good practice.
  • Inadequate – The service is performing badly and action has been taken against the person or organisation that runs it.  The provider is in breach of one or more regulations and is not meeting some of the fundamental standards. Service users are receiving care that may be unsafe, careworkers are not supported.

Interested in finding out more about technology and the CQC and CQC ratings? Read our resource guide.