changing the way cqc regulates, inspects and monitors care
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Changing the way CQC regulates, inspects and monitors care
Adult social careMay 2014
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Our purpose and role
Our purposeWe make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve
Our roleWe monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care
We will be a strong, independent and expert inspectorate that is always on the side of people who use services
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Adult social care visionThe Mum Test
Is it safe?
Is it caring?
Is iteffective?
Is it responsive to people’s needs?
Is itwell-led?
Is it good enough for my Mum?
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Our new approach
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Making the Mum Test Real
Communication
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What will be different?
Now
Future
Risk based model More targeted
Caseloads More manageable
Making judgements On the 5 key questions
Enforcement when needed
Commitment to taking firm action
Publishing our findings
Clearer reports
Ongoing monitoring Better information
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Timetable
Co-production and development to shape consultation proposals
Oct 2013 – March 2014
Consultation on regulatory approach, ratings and guidance
April 2014
Wave 1 pilot inspectionsApril – May 2014
Evaluation; guidance and standards refined.
July – Sept 2014
Wave 2 pilot inspections and initial ratings of some services
June 2014
Oct 2014
New approach fully implemented and indicative ratings confirmed
March 2016
Every adult social care service rated
4 June:Consultation
closes
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Inspection principles
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What will be different?
Intelligent monitoring
Provider information return
Questionnaires – community services
Sharing information with external partners
Inspections
6 months – 2 years
Tailored inspection teams
Increased use of experts
Experts by Experience
Specialist Advisors
Our key questions and key lines of enquiry
We will no longer focus solely on whether providers are compliant or non-compliant with regulations
Our focus is on the five key questions about services:
Is it safe?
Is it effective?
Is it caring?
Is it responsive?
Is it well-led?
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Principles for our key lines of enquiry
For each of the five key questions there are mandatory key lines of enquiry
There will be additional key lines of enquiry based on:
An inspector’s knowledge of the service
Information available
The inspectors professional judgement
They support consistency of what we examine under the five key questions and focus on those areas that matter most
Key lines of enquiry are supported by guidance on the ‘key things to consider’ as part of the assessment – these are called prompts
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Safe
By safe, we mean that people are protected from abuse and avoidable harm.
In adult social care, this means that people are supported to make choices and take risks and are protected from physical, psychological or emotional harm; abuse, discrimination and neglect.
Key line of enquiry example:How are people protected from bullying, harassment, avoidable harm, abuse and breaches of their human rights?
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Effective
By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.
In adult social care, this means that people are supported to live their lives in the way they choose and experience the best possible health and quality of life outcomes.
Key line of enquiry example: How are people’s needs and choices for care, treatment and support met?
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Caring
By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect.
In adult social care, this means that people, their families and carers experience care that is empowering and provided by staff who treat people with dignity, respect and compassion.
Key line of enquiry example: How are positive, caring relationships developed with people using the service?
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Responsive
By responsive, we mean that services are organised so that they meet people’s needs.
In adult social care, this means that people get the care they need, are listened to and have their rights and diverse circumstances respected.
Key line of enquiry example: How do people receive personalised care that is responsive to their needs?
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Well-led
By well-led, we mean that the leadership, management and governance of the organisation assure the delivery of high-quality care, supports learning and innovation, and promotes an open and fair culture.
In adult social care, this means that people get the care they need, are listened to and have their rights and diverse circumstances respected.
Key line of enquiry example: How does the service promote a positive culture that is person centred, open, inclusive and empowering?
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Q&A
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Ratings
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Four point scale
High level characteristics of each rating level
Innovative, creative, constantly striving to improve, open and transparent
Consistent level of service people have a right to expect, robust arrangements in place for when things do go wrong
May have elements of good practice but inconsistent, potential or actual risk, inconsistent responses when things go wrong
Severe harm has or is likely to occur, shortfalls in practice, ineffective or no action taken to put things right or improve
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How key lines of enquiry and evidence build towards ratings
Intelligent monitoring and local information
Pre-inspection information gathering
On-site inspection
Speak to staff and
people using the
service
Key lines of enquiry
(mandatoryplus
additional KLOEs
identified from
information held)
Gather and record evidence from all
sources
Define the questions to
answer
Write report and publish alongside
ratings
Outstanding
Good
Requires improvement
Inadequate
Apply consistent principles,
build ratings from the recorded evidence
Make judgements
and build ratings
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How do we decide a rating?
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To what do we give ratings?
Services will be rated at two levels:
level one - we will use our rating methodology and professional judgement to produce separate ratings for each of the five key questions
level two - we will aggregate these separate ratings up to an overall location rating using ‘ratings principles’
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Principles
The five key questions contribute equally to the overall location rating. Overall ratings are produced using the following principles:
•If two or more of the key questions are rated ‘inadequate’, then the overall rating will normally be ‘inadequate’
•If one of the key questions is rated ‘inadequate’, then the overall rating will normally be ‘requires improvement’
•If two or more of the key questions are rated ‘requires improvement’, then the overall rating will normally be ‘requires improvement’
•At least two of the five key questions would normally need to be rated ‘outstanding’ before an overall rating of ‘outstanding’ can be awarded
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Rating limiters
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Q&A
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Other ways to share your views
Consultation: 9 April to 4 June 2014
Get involved:
Web form at www.cqc.org.uk
Twitter @CareQualityComm
Email CQCchanges.tellus@cqc.org.uk
Provider online community: join at www.cqc.org.uk
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www.cqc.org.ukThank you
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