How can I fix my CQC ratings?

17 January 2024 By Mike Bowyer

Depending on what your current rating is, The Care Quality Commission (CQC) will inspect a care home every 1 – 5 years. There are 4 possible ratings that health and social care services can receive:

  • Outstanding – the service is performing extremely well

  • Good – the service is performing well and meeting all expectations

  • Requires improvement – the service is not performing as well as it should and the service has been given points to improve on

  • Inadequate – the service is performing badly and the CQC will take action against the person or organisation that runs it.

These ratings are extremely important, and the main aim of the CQC ratings is to ensure that every care provider and setting has a high standard of patient care and compassion. The CQC will rate each establishment on fundamental standards that health and social care settings should never fail on. The CQC is on the side of the residents and the service users, and the inspection is there to ensure that residents are being looked after properly and in the correct manner.

What is involved with a CQC inspection?

There are 5 key criteria that the service will be assessed on during the CQC inspection:

  • Safety – to ensure that the service users, residents, and the staff are safe and protected from harm and abuse

  • Effectiveness – simply ticking boxes is not enough, you must ensure that all actions such as level of care, treatment and support are carried out to a high level

  • Care – to ensure that staff are treating those in their care with compassion, respect, and dignity

  • Responsiveness – not every resident is the same, and you must ensure that your service is responsive enough to help those with varying needs. Care needs to be based on the individual rather than the majority.

  • Leadership – leadership is much more than simply managing staff and is crucial to the entire process. You need to make sure that the organisation promotes a fair and open culture, as well as encouraging innovation and learning among the staff members

During the inspection, the CQC will gather evidence on your service by speaking to your employees, listening to what people say about your service and using various inspection methods such as observing, looking at individual care paths, reviewing residents’ records, looking at policies and procedures in place and inspecting the areas in which people are cared for.

Once the CQC inspectors have completed their visit, they will gather the senior members of staff for a feedback meeting. In this meeting, they will:

  • Summarise what they found during the inspection

  • Outline any issues that they may have come across

  • Talk through any action that may require immediate attention

  • Tell you if they have any announced inspections coming up

  • Let you know how their decisions will be made and published

Following this meeting, the CQC will publish the report on their website, and it will include a rating of either outstanding, good, requires improvement or inadequate. To ensure consistency, the CQC has a dedicated quality panel who will oversee samples of their judgement so that everyone is judged the same and fairly.

Once this report is published, you must respond to any areas of concern outlined in your report and create an action plan focusing on what you need to tackle. Once you have made all the required improvements, the CQC will follow up either by re-visiting your site and carrying out an inspection focused on the concerns, or with a phone call or email for you to detail all the changes you have made.

Top tips for improving your CQC rating

No provider wants to receive a rating of ‘requires improvement’, and it can only take two of the key questions to be rated ‘requires improvement’ to bring the whole rating down. There are also some instances where, despite how outstanding or well managed your care may be, you can automatically be awarded an instant ‘requires improvement’ where there is a breach of CQC regulations present. Examples of this include not having a registered manager hired, not returning PIR information when requested, or statutory notifications not being submitted. It is also important to note that if you are a new service, or you have recently been taken over by another company, you will probably have been inspected but not rated. The CQC may delay or suspend a rating if they find anything that requires a re-inspection from the previous rating.

If you receive an inadequate CQC rating, the process following the inspection will be slightly different. Following an inadequate inspection rating, you will be given a 6-month turnaround period. After 6 months, inspectors will return expecting to see significant changes to how your service is run. If improvements have not been made, there will be another 6-month period, however during these 6 months the Care Quality Commission will take steps such as embargo (which prevents new residents from being taken on.) If improvements have still not been made after the second 6 months, the CQC may move to have the service closed down.

With all this in mind, we have put together some tips to help you improve your rating if you have received a low rating.

  • Document everything! Make sure that you have strict documentation procedures in place, and that all staff are following these correctly. All the documentation needs to be clear and accurate in case anything should go wrong. If you haven’t already, consider moving to a digital care management system already – it will help to keep all documentation correct and easily accessible.

  • Go through your recent or previous CQC reports and make a list of all negative comments and feedback. Next, you will need to write up an action plan and steps that will help you improve each area. It helps if you do this as an organisation rather than one individual, so that everyone knows what is expected of them

  • Managers should regularly ensure that risk assessments are in place and that all procedures are being followed correctly. Inaccurate, misplaced or risk assessments that don’t include any follow up actions can bring down your ratings instantly.

  • Check all the current CQC guidance on medicines management and ensure that all staff have up to date training in this area, as this is something that will bring down many organisations.

  • Review all mandatory training requirements and identify if any staff need any additional courses. Create a schedule for all staff to attend ongoing training sessions and stick to it!

  • With staff shortages it can be tempting to hire anyone who applies, but it is vital that you have a proper vetting and verification procedure in place. CQC inspectors will watch staff closely, and you need to ensure that you seek references from past employers and that all staff have been DBS checked.

  • Ensure that all care plans are based on the individual and not simply task based. Electronic care plans can ensure compliance, and they can be more easily personalised to the person and shared with the residents care circle.

Remember, receiving a low rating does not mean that you are doing everything bad. The CQC has been put in place to ensure that residents and service users are being cared for properly and with compassion, and an inadequate or requires improvement rating can be seen as an opportunity to make the service better for everyone involved. Only 1 in 200 organisations will receive an outstanding rating, and with everyone taking the correct steps and measures you will be on your way to achieving this as well.

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