Up until the onset of the COVID-19 pandemic, all providers of health and social care services in England, including community residential care facilities, were subject to annual quality audits by independent regulator the Care Quality Commission (CQC).
The CQC monitors and inspects all adult health and social care services, including primary care, NHS trusts, independent healthcare providers, community residential care homes and nursing homes, to check whether they are meeting fundamental standards of quality and safety.
In response to the onset of the pandemic last year, the CQC announced that it had temporarily suspended routine inspections of community residential care homes and nursing homes. Since that time, they have put into place a transitional monitoring approach, to support and monitor services without the need for face-to-face inspections. This involves online and / or telephone conversations with providers and their staff, in addition to reviewing information already held by the CQC in relation to your service. In addition, the CQC plans to use technology and existing local relationships to improve contact with service users and their families. Whilst this is not the same as an inspection, it will provide the CQC with the information that they need to decide whether further action is required.
You can find more information about what questions will be asked during the monitoring call here.
COVID-19 and quality in social care
In order to quantify what is meant by ‘quality’ in social care, the CQC has devised its own fundamental standards of care, which sit alongside existing health and social care legislation. All social care providers in England must meet these standards, in order to demonstrate that they are providing either good or outstanding services. The standards address some of the following aspects of care:
- Dignity
- Protection from abuse
- Person-centred care
- Good governance
- Staffing
Although the CQC is not actively carrying out regular audits of community residential care homes, the fundamental standards should still be incorporated into all aspects of service user care.
Of course, there have been many additional challenges faced by the health and social care sectors since the onset of the COVID-19 pandemic. There is guidance for providers of community residential care homes about this on the CQC website.
What are the CQC’s audit tools?
Under normal circumstances, CQC quality audits address five ‘key questions’ about the service and standard of care. They include:
- Are they safe (are service users protected from abuse or harm)?
- Are they effective (does care, treatment and support achieve positive outcomes and support service users’ quality of life)?
- Are they caring (do staff treat service users with dignity, compassion, kindness and respect)?
- Are they (staff) responsive to people’s needs?
- Are they well-led (does leadership promote innovation, learning, and an open and fair culture)?
In the past, CQC inspectors have used a combination of the following practices to address the key questions:
- Collecting comment cards and complaints
- Interviews with staff and service users
- Observing care practices
- Inspecting records
- Reviewing care pathways
- Inspecting the home, its facilities and cleanliness
- Reviewing documents and policies
However, as a result of COVID-19, the key questions are currently being addressed through a combination of telephone calls with staff, existing information held by the CQC about the service and communication with service users and their families. Inspections will only be carried out if it is felt necessary.
What is the purpose of auditing in the care setting?
The CQC is responsible for ensuring that service users are provided with safe, effective, compassionate and high-quality care at all times, as laid out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission Registration Regulations (2009).
The role of the CQC is not only to inspect services; they are also empowered to take necessary action whenever poor care is identified. This action could include:
- Issuing requirement/warning notices setting out improvements which must be made
- Altering a provider’s registration
- Placing a provider in ‘Special Measures’ (in cases where drastic improvement is required)
- Issuing cautions or fines
- Closing providers down
- Prosecuting negligent providers
CQC reports and subsequent actions are available for the public to view on the CQC’s website.
Even though the CQC is currently using a different system of monitoring health and social care services, inspections are still carried out in cases where it is deemed necessary, for example if there have been complaints about a service or if there are concerns about risk to residents - after all, patient safety is paramount to these inspections.
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