The Care Inspectorate and the Care Quality Commission
The Care Inspectorate regulates and inspects care services in Scotland to make sure that they meet the right standards. In England and Wales, they have the Care Quality Commission (CQC) which has a similar function.
These main bodies regulate the care sector. They have a role to play in getting alongside and supporting most care related services across all ages including adoption and fostering services, childcare and child minding, care homes and in-home care for the elderly. Whilst their primary function is not to police services but to serve and assist services, they do also have powers to close down services if it were in the public interest and a service continually failed to meet the right standards. We pay an annual fee to register all of our in-home care services with them. This video might give you more insight into their role:
Registering care services
When a care providers like ours sets up a new service in a new area, we need to register with the care inspectorate. We are charged an initial fee and the registration process can take around 3-9 months.
Registration is split into three main parts. Firstly digging into who the registered provider is. The registered provider is the limited company or organisation who owns the service and has financial responsibility for it. For example Bright Care at Home Ltd is a registered provider, so they want to know what the story of this company is and the people involved in running it – are they fit and proper people? Does it has a stable and responsible history? Secondly finding out more about the proposed registered manager and their suitability to lead a service. This is the person, usually employed by the provider, with the day to day management responsibility for the safe and effective delivery of the service. Who is this person? Are they of the right calibre to be managing such a critical service caring for vulnerable people? It should be noted that in smaller services people who are involved as the registered provider may also have a significant part to play in running the day to day service too.
The third part of registering a service is all about the policies, processes and people that will be in place to ensure the business is well run.
It is important for the care inspectorate to be satisfied that providers have the right quality of staff in place and that the provider has a throughout understanding of what it takes to run a care service and all the things they should be aware of and thinking about before they approve the registration
One area of the sector that currently escapes regulation is care brokers/introducers. These are companies who act only as an introducer. They match clients to care staff but do not actually employ the care staff themselves. The workers will operate as self employed individuals and will invoice families directly for their services. Such organisations do not need to operate to the same stringent standards as regulated services, particularly with regard to recruitment practices and on-going staff training and development.
Pre Inspection Questionnaires
Whilst all well run care services will be really good at collecting and acting on feedback from its customers and staff, the Care Inspectorate also send out questionnaires to both to obtain their own feedback. The Care inspectorate do not have the right to hold private data on the customer base of a care provider so providers undertake logistics of getting the questionnaire out themselves. These are posted out to staff and clients few weeks before an inspection is due.
These questionnaires aim to get an impression of the overall levels of satisfaction within the service.
Inspectors will visit every care service they regulate around once a year. Inspectors talk to people using the service, staff, managers and owners. They get a sense of what happens in the service on a day-to-day basis to help assess the quality of care people receive.
The ideal scenario is that a service has the same inspector year after year so that the manager can work with the inspector and draw on their knowledge and experience to seek opportunities for improvements and new ideas and build on them year by year.
Sometimes care inspections can be seen as a time consuming and somewhat a hassle for busy service managers but when a care service gets an inspector who really understands their business and gets behind it, the change and improvement that can be effected can be significant. It is very satisfying when care services and inspectors create synergy through building a fantastic working relationship.
Some inspections are ‘announced’, while others are ‘unannounced’. The definition of ‘unannounced’ varies depending on who you speak to but most inspectors should give a few days notice. This notice is just a common courtesy to ensure a busy manager can actually clear out their diary and be around to spend time with the inspector! However, most providers will be able to effectively predict to within a couple of month when they would expect an inspection.
Like preparing for an exam in school, it can be tempting to feel the need for lots of pre inspection box ticking and general ‘getting the house in order’ but a well run service has nothing to hide and should always be ready for inspection, any day any time.
The grading system
Care services are graded from 1 – Unsatisfactory to 6 – Excellent. As with any subjective grading system, grades in services can fluctuate plus or minus a level depending on who the inspector is. Grades should not be relied on alone though. They do not tell the whole story. An service rated excellent last year could have new management running it into the ground, whilst a poorly rated services last year could now have a new highly responsive manager working hard to change and improve things quickly.
However, we would suggest that steady year on year grades between ‘Good (4)’, ‘Very Good (5)’ and ‘Excellent (6)’, would generally indicate a stable and well-run service.
Care Inspectorate reports
These reports accompany the grades a service is given. You will be able to get a much better insight into the culture of a service or the quality of a manger from reading the report. An inspection report should still never be used a sole indicator of the quality or suitability, from which you can make a decision on a service for you or a loved on, the only way to do that is interview the service yourself. You might find this article helpful, 12 Quality Questions to ask when Selecting a Care Provider. However, it is a tool that can provide good quality insight into both the areas the service is really strong in and the areas in which it is working to improve. Within the report you would typically find references to ‘requirements’ and ‘recommendations’. Requirements are improvements that a service must work to meet and these will be checked at the next inspection, whilst recommendations are ideas that could improve the service but implementation is at the discretion of the manager. Look out for ‘met’ or ‘unmet’ in relation to previous requirements, requirements that remain continually unmet over a longer period of time might indicate a lack of attention towards improvement.
In the care sector the inspection and care regulation process is driven by the principle of ‘if its not recorded, it did not happen’. Everything needs to be evidenced. A poor inspection report may be a lack of documented evidence rather than actual poor care practice within the service, however a lack of documentation is poor practice.
Ensuring the constant recording of everyday information can redirect precious time and resources that could be argued would be better directed into client care. The added ‘burden’ of regulation will always drive up the costs in any industry for end users but there is no doubt that efficient and responsive regulation is healthy and helps drive up standards and consumer confidence which in turn leads to better delivery at the coal face.