REGULAR An Inspector Calls


Tomorrow’s Care columnist Richard Bates, partner and head of the later life team at Rix & Kay Solicitors, takes the mystery out of CQC inspections for residential care providers awaiting their first visit.


Inspections (together with Intelligent Monitoring) are the key way in which the CQC evaluates the quality of a service being offered by a registered provider. Given the large volume of providers and relatively limited resources of the CQC, it is essential that inspections are done efficiently and uniformly. By having an overarching process, the CQC also aims to temper the long-time complaint that inspection results depend simply upon ‘who you got on the day’.


Inspectors gain insights by use of Key Lines of Enquiry (KLOE) – formulaic questions about the delivery and processes involved in a service. Some KLOEs are mandatory and are assessed at every visit, while others are driven by the situation ‘on the ground’ or as a result of the Intelligent Monitoring process.


Inspections are usually announced 48 hours in advance and are carried out by either a single inspector or team of inspectors. The team can involve Experts by Experience – people with personal experience of services either directly themselves, or from being a carer. The Experts by Experience contact service users and other stakeholders for opinions and then feed back to the inspector.


Inspection frequencies will depend on the rating of the service:


• Inadequate – 6 months


• Requires Improvement – within 1 year


• Good – within 18 months • Outstanding – within 2 years


In addition, there can be inspections that either respond to a risk that has been raised or follow up on any


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action the CQC has directed the service provider to make. Finally, the CQC plans to inspect 10% of randomly selected ‘good’ and ‘outstanding’ services each year that are not due an inspection in accordance with the timescales above. This is, in effect, a quality check.


Site visits Visits begin with a meeting and the inspector will expect to see the manager, registered person, nominated individual, or senior person in charge.


Given the large volume of providers and relatively limited resources of the CQC, it is essential that inspections are done efficiently and uniformly.


The inspector will inform the service of which KLOEs will be inspected and:


• Whether they are following up on any previous issues


• The proposed length of the inspection


• The roles of the inspection team members


• Who they plan to speak with • Documents they want to review


• How they will feed back about what was found during the inspection


During the visit, views will be gathered about the service from people who use it, individually or in groups, including speaking to families and visitors. Information will be gathered from staff at all


levels of seniority and throughout the service. In addition, service providers can expect the inspectors to:


• Observe (non intimate) care


• Review individual care pathways (care plans)


• Talk to other stakeholders • Consider the physical environment • Review records


How will CQC ratings be


awarded? In its Provider Handbook, the CQC indicates that: “Inspection teams will base their judgements on all the available evidence, using their professional judgement. They will particularly use the key lines of enquiry, the prompts and our guidance on the ratings levels”. Therefore, the inspection will be the most important element of the ratings system, albeit that Intelligent Monitoring will have an impact.


The CQC will apply the ratings methodology and the inspectors’ professional judgement to give a rating for each of the five key questions – Safe? Effective? Caring? Responsive? Well-led? For each of the five key questions the inspector will ask themselves:


• Does the evidence demonstrate that we can rate the service as good?


• If yes – does it exceed the standard of good and could it be outstanding?


• If no – does it reflect the characteristics of requires improvement or inadequate?


Services are rated ‘Inadequate’ where one or more regulations


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