2. SEN/RGN: 1978 to 1995.
Clinical history: ophthalmology, general surgery /medicine, T and O
and day surgery, plastics .
Nurse manager: 1995 to 2000
CCG manager: 2000 to 2010
Private sector acute site, (care home and housing regional
management: 2010 to September 2014 (BUPA, BMI, Anchor Trust &
Shaw Healthcare)
Survival Solutions: October 2014
3. CQC background & history, current and past political issues
New ways of inspecting
How to Prepare
What to Expect when you are Inspected , how to respond, common pitfalls, samples of reports
Potential future for regulation
Session plan: 2 – 3 hours with comfort breaks
4. A regulatory body & part of the DOH
Established in 2009 via the Health and Social Care Act 2008 to establish a
single regulator for health and social care, after a decade of poor practice
Replaced CSCI and the Healthcare Commission & mental health commission
New set of regulations after healthcare scandals ( Winterbourne ) in 2013 and
Stafford
From 2014 includes dentists, GPs and homecare suppliers
Exists to monitor safe delivery of healthcare & to promote improvement
5. Chair: David Prior ( Formerly Tory politician) and CEO: David Behan
Chief Inspectors: Mike Richards (hospitals ) Andrea Sutcliffe ( social
care & Steve Field ( GP) John Milne (Dental-Jan 2015)
Not without is chequered past! ( Winterbourne, Morecambe Bay,
Stafford )
6. Specialist practitioners now in place
Times of visits and duration can vary: days nights & weekends. 1 to 2 days are
the norm but can be weeks at an acute trust. Can work with MBC,SW’s and
CCG to triangulate information and vary their visits with these staff over months
of time. Recent inspection at UHB /QE in Edgbaston: 3 weeks .
May return unannounced during the 2 weeks after the visit to follow up
Themed inspections e.g. dementia
Response to a concern or complaint.. Can be maliciously based
Should give notice ( this varies ) but not usually in a care home
They have to be allowed access ( unless a dire emergency that affects client
care) E.g. Recent events at The Hawthorns
7. Looking to establish ‘CREWS’ where the service must be :
Effective.
Caring.
Responsive.
Well led.
Safe. (abuse, safeguarding, consent, meds issues)
NB: CQC have defined the characteristics of all these definitions and have prompts to
lead their discussions and questioning to enable them to make a decision on the
outcomes.
8. Outstanding
Good
Requires Improvement
Inadequate
NB There is no ‘average,’ ‘satisfactory’ or ‘acceptable’ and no
‘very good’!
9. Ongoing local information about the provider: Staff, carers &
complaints.
Intelligent Monitoring: user & staff surveys
Pre inspection: CQC records & other stakeholders: CCG, MBC
On site direct and indirect observations & inspections:
records, policies, environment, what carers tell them
10. The fundamental standards are:
• Care and treatment must be appropriate and reflect service users' needs and
preferences.
• Service users must be treated with dignity and respect.
• Care and treatment must only be provided with consent.
• Care and treatment must be provided in a safe way.
• Service users must be protected from abuse and improper treatment.
• Service users' nutritional and hydration needs must be met.
• All premises and equipment used must be clean, secure, suitable and used properly.
11. • Complaints must be appropriately investigated and appropriate action taken
in response.
• Systems and processes must be established to ensure compliance with the
fundamental standards.
• Sufficient numbers of suitably qualified, competent, skilled and experienced
staff must be deployed.
• Persons employed must be of good character, have the necessary
qualifications, skills and experience, and be able to perform the work for
which they are employed (fit and proper persons requirement).
• Registered persons must be open and transparent with service users about
their care and treatment (the duty of candour).
13. Introduction where CQC will explain their day’s plan to manager on site.
Will be an ‘expert by experience’
Mix of observation, chatting to staff, clients, carers and managers.
Triangulate information with NHS managers, MBC, SW s, AHP teams, GP ‘s.
Will look at documentation, (consent, care plans and care records, commercial
records, training records, feedback sign off and presentations, policies and
procedures, safeguarding documentation, client, carer and staff feedback forms )
14. PIR report requested /jungle drums !
Will follow up on areas in PIR at visit
Show around and offer coffee ( beware here!)
Leave alone but be cooperative
They may give a rough timeline & agree a loose day s plan
Feedback at days end
15. Preparation is key:
Hold a team meeting after PIR completed and discuss areas on PIR, and ensure they
are aware of what the inspector will look at
Discuss what you may have problems with and put in an action plan on this NOW
Fully brief staff on how to behave, what to say but be aware that comments can be
misconstrued very much.
Feedback: Take copious notes and agree these when feedback session in progress
Be professional but don't show overly concern at the visit.
CEO/manager must be present – alert if out on visits
16. Storage & Administration of drugs especially CD s
Using other clients drugs
Not being aware of drug side effects
No drug review e.g. antibiotics, BP tablets, statins
Record keeping... Where do I start ?!!
17. Covert administration e.g. in cereal. NB Check policy!
Consent to administer
Gaps on MAR sheets
No valid/expired prescription
Administering without signing for drugs etc
Giving in a job lot on a tray with unmarked medicine pots
or without taking the prescription sheet with you to the
client
18. ‘Successful management of quality requires
truthfulness about the problems and then effective
action to improve. We are supplying the former; it
is up to the service to respond by acting on it.’
Last updated:19 January 2015
19. Be very careful ..what you don’t say is as important as what you do say!
Be honest .. but circumspect
Don't give a plethora of information not relevant or requested
Be professional: maintain eye contact, have a quiet environment, set
aside time to talk to the inspector, turn OFF your phone: DO NOT
maintain a relationship with it during the chat with CQC
Give 1:1 commitment to the interview but ensure client safety.... You
cannot refuse a visit unless safety or dignity is compromised or carer
agreement withheld
20. Highlight positive improvements or thing you feel proud of or
issues that you are working on
Be enthusiastic & positive.
What do SU’s like best.
What has worked well/poorly. What are we trying to improve
on and what progress have we made
Be aware of latest developments, improvements/critical
issues/complaints in the service.
21. If training is a problem explain why and what the team are doing
about it ..ALWAYS put a positive spin on it
‘Oh yes we never see our manager..
OR ...’However we have a team meeting shortly to sort this out and I m
confident that it will be sorted due to XYZ actions being taken’
‘Oh no we never give covert meds’ .. Whilst doing this !
‘I hate working here.’
‘I’m leaving soon anyway ‘
22. More regulation... not less
Media and CQC exposure of poor care
Increased powers of CQC re enforcement and MBC (Councils)
Larger organisations & the reduction of smaller care provider’s
More CQC errors, challenges from GP s and NHS trusts.
Recent Southend GP challenges and NHS Hinchinbrook.
