Andrea Sutcliffe, CQC's chief inspector of adult social care, has said that under the new inspection system larger care homes find it harder to achieve an 'Outstanding' rating than smaller care homes, despite smaller homes struggling more to meet the current financial difficulties.

In an interview with a sector magazine, Sutcliffe stated that "the smaller and medium sized care homes are having much more positive ratings, in terms of Good or Outstanding, compared to the larger or very large services".

There has been a lot of press commentary recently (see our blog article here) on the financial struggles of the care sector in light of decreased funding from local authorities, the National Living Wage and the introduction of auto-enrollment pensions. Those providers who are still building new homes prefer larger homes with 60 or more beds, where economies of scale provide a greater chance of turning a profit. However, larger homes appear to struggle to provide the personal touch and attention to detail required to step up from a Good to an Outstanding rating. CQC's recent State of Care report highlighted some of the key themes it saw in outstanding adult social care:

"[They] have a culture of care that both puts the views and wishes of each person at the centre of their care, and supports staff to deliver that care. Values are embedded in the organisation and demonstrated in practice. Managers make sure their staff receive continuous development and training, and they carry out regular audits so that shared learning can prevent future risks to people’s safety, health and wellbeing. Staff involve people using the service and their family and carers to develop care plans. They keep plans close at hand and regularly reviewed so that the care being delivered is always reflective of people’s needs."

As we have commented on previously, many providers who have focussed on the luxury end of the market (where reduced local authority payments are less relevant) are at risk of emphasising high spec buildings and furnishings, potentially at the risk of missing smaller details such as recruiting the right (not just enough) staff and creating a truly homely atmosphere. In particular, Sutcliffe commented on the importance of managers being able to know well the entirety of the home they are responsible for, and the recruiting of not just sufficient staff, but highly skilled staff. While certain requirements, such as staffing levels, are mandated by CQC, other details, such as making sure every residents' preferences are catered for, are easier for a small home to provide.

Sutcliffe summed up this problem as focussing on what looks good, not what feels good. While the vast majority of providers, especially at the luxury end of the market, will be able to meet CQC's standards in order get a Good rating, in order to push the rating up into 'Outstanding', care homes will need to make sure they are providing just that – homes, not hotels.