CQC inspections It is therefore important that upon
receiving a draft report, providers calculate the correct deadline and, in cases where the CQC’s covering letter is dated prior to the date a provider receives their draft report by email, it would be advisable for providers to email their inspector to obtain written confirmation of the correct deadline. This will ensure that providers benefit from the full 10 working day period and that their report is not published before it has been properly quality checked through the factual accuracy process.
Case Study – Factual Accuracy Challenge (May 2023) We were recently instructed to act on behalf of a care home provider which is registered to accommodate people with physical disability and/or complex healthcare needs. The CQC carried out a comprehensive inspection of their service and the draft inspection report set out a rating of ‘Good’ in four of the key domains and ‘Outstanding’ in the fifth domain, with an overall ‘Good’ rating. We were instructed to submit a factual
accuracy challenge in response to the draft inspection report on behalf of the provider, which included a challenge of the ratings and a submission that the overall rating should be upgraded to ‘Outstanding’. Within that challenge, we made detailed submissions as to why the inspector had incorrectly rated the service with reference to their own findings and the CQC’s key lines of enquiry and ratings characteristics. One of the CQC’s key ratings principles is that at least two of the five key questions would normally need to be rated as ‘Outstanding’ and three key questions rated as ‘Good’ before an aggregated rating of ‘Outstanding’ can be awarded. We therefore needed to successfully challenge at least one of the ‘Good’ ratings in order to change the overall rating of the service. In May 2023, the CQC responded to our factual accuracy response, confirming that the rating in the ‘Responsive’ key question had been changed from ‘Good’ to ‘Outstanding’ as a result of their re- evaluation of the available evidence, and the overall rating for the service had been changed to ‘Outstanding’.
How do I challenge a CQC inspection report after it is published? After an inspection report is published, a provider can request a review of the ratings within the final inspection report. The request must be submitted to the CQC using
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the correct online form within 15 working days of the publication of the report and not before publication. However, the only ground for requesting
a review is that the inspector has not followed the correct process for making ratings decisions and aggregating them. You cannot request a review solely on the basis that you disagree with the judgements made by the CQC.
The CQC will consider whether the
request for a review falls within the permitted grounds and, if so, the review will be dealt with by CQC staff who are independent from the initial inspection report. It is, however, important to note that if the CQC does not uphold a request for review, you are unable to lodge a subsequent request to review the ratings of the same inspection report. It should also be noted that a ratings
review can result in an increase or decrease in the current ratings and the full request is limited to 500 words in total. Due to this word limit, ratings reviews are difficult to obtain and there is no guarantee that a request would result in a change in the ratings. The most recent statistics published by the CQC put success rates at around 5.85 per cent for adult social care providers. Only 45 of 769 providers achieved an increase in ratings, re-inspection, or reconsideration of the report. Having said this, however, it remains the only route open to a provider to attempt to change any rating and put their concerns on record.
Case Study – Ratings Review (February 2023) A care home provider instructed us to request a review of their ratings. They had already submitted a detailed factual accuracy challenge which resulted in a number of changes to the report; however, the ratings remained the same. We made a request with reference to the CQC’s ratings guidance and the provider’s factual accuracy challenge within 15 days of publication.
After considering our request, the CQC accepted that their findings within the ‘safe’ and ‘well-led’ domains should be reviewed again against the ratings characteristics, and the report was sent back to the inspection team to consider the impact of these changes on the ratings. In the meantime, the inspection report was withdrawn from publication. Once considered, the ratings in both in the ‘safe’ and ‘well-led’ domain were changed to ‘Good’ which resulted in an improved overall rating for the service of ‘Good’ instead of ‘Requires Improvement’. These cases demonstrate the importance of challenging an inspection report and ratings both before and after publication, and the impact such challenges can have on both the contents and ratings within a report.
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Laura Hannah
Laura Hannah is a partner in the regulatory department at the law firm Stephensons. Laura specialises in professional discipline and health and social care regulation, and represents providers and managers in relation to proceedings before the CQC, Care Inspectorate Wales (CIW), and Ofsted, providing advice on compliance, registration, enforcement action, and appeals to the first-tier tribunal (Care Standards Chamber).
www.thecarehomeenvironment.com February 2024
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