As with the majority of organisations, the CQC (the regulator and inspection body of health and social care services sector in England) has made changes to the way it works during the coronavirus (Covid-19) outbreak. It includes how they undertake their work including regulatory activities.
Many of you will have seen that, on 16 March 2020, the CQC:
- ceased routine inspections (inspection activity remains in a small number of cases, for example where there are allegations of abuse)
- commenced engaging remotely to provide assurance of safety and quality of care
- said that they would provide extra support to registered managers in adult social care.
The CQC has further stated that they encourage service providers to act in the best interests of the health of the people they serve, with the top priority the protection of life and for discretion to be used and to act in the best way they see fit.
This last phrase may appear to be a relaxation of the CQC fundamental standards, but from our experience the opposite is most definitely the case. We believe that, once inspections resume, the CQC will be issuing Warning Notices on those providers who, in the eyes of the CQC, have fallen short of the fundamental standards, even though, in most cases, care providers have gone above and beyond their duties in such extraordinary times with little external help or resource.
Top tips for ensuring compliance immediately post-pandemic
The CQC can issue Warning Notices where the quality of the care falls below what is legally required. For some regulations of the Health and Social Care Act 2008, the CQC does not first need to issue a Warning Notice before it is able to prosecute, as they relate specifically to harm or the risk of harm, or are requirements imposed by CQC.
The CQC inspection focuses on identifying non-compliance, cross-checking observations against other evidence such as care plans and training records. Understanding that the CQC inspectors assess health and social care services using the five key lines of enquiry (safe, caring, responsive, effective, and well led), the two key areas of the inspection regime are safety and leadership. Specific concerns surrounding poor training and lack of evidence of risk management seem to be prevalent issues.
With this in mind, we would recommend concentrating on the following aspects post-pandemic:
Record keeping and paperwork
- You should check paperwork is up to date, especially your ‘statement of purpose’ and applicable health and safety risk assessments and method statements.
- Documentary evidence is key to any inspection – if you are unable to demonstrate compliance, an inspector is unlikely to be satisfied you are complying with the legal requirements.
- Update your CQC folder of relevant information to show inspectors. This should contain your policies, procedures and also good news stories (such as positive feedback/compliments from stakeholders).
- As government guidance is changing rapidly, it would be wise to record how you have received this guidance and how you are adapting to it and putting it into practice.
- Refresh staff knowledge about the CQC so that they understand what role it plays and how it operates.
- Look at training relating to safeguarding and provide refresher learning and development opportunities.
- Make sure that your staff know where they can access key information such as key telephone numbers and up-to-date copies of the practice’s policies and procedures.
Equipment and patient safety
- Inspectors will wish to see evidence of reliable systems, processes and practices in place to keep people safe, which includes maintaining equipment.
- The provision, maintenance and repair of equipment and devices used in the care home also forms part of risk assessment activity under the Management of Health and Safety at Work Regulations 1999 and the Provision and Use of Work Equipment Regulations 1998.
- Ensure that all lifting equipment has been independently inspected as per the Lifting Operations and Lifting Equipment Regulations 1998.
- You should document all efforts to obtain PPE and your decisions to re-use it if applicable.
Be inspection ready
Whilst the current circumstances are certainly unprecedented, normality (or at least a new form of it) will eventually prevail. We are starting to see other nations relax their restrictions (for example, dental practices in Norway and Denmark have reopened for routine dental work as of 20 April 2020). When normality returns here we advise being ‘inspection-ready’. Remember that ‘if it is not written down, it did not happen’ continues to apply.