The Care Quality Commission (CQC) is a Department of Health and Social Care sponsored regulator of health and social care services in England. It has wide ranging powers to meet its statutory objective and hold registered providers and managers to account. Its enforcement policy sets out how it will approach breaches of the regulations to protect service users; and it is not shy at using them. It is therefore important that those working in the care sector understand how the CQC operates, and how to work with the regulator in a collaborative manner.

How does the CQC regulate?

The CQC’s main statutory objective is to protect and promote the health safety and welfare of people who use health and social care services, such as hospitals, GP surgeries and care homes. Service providers are required to register with the CQC which involves demonstrating compliance with a set of regulatory requirements including fundamental standards of quality and safety. Once registered, providers will face regular inspections and be given a rating which they are required by law to display on their premises. The ratings can be extremely important in terms of reputation, amongst other matters. The CQC provides service providers with a set of safety and quality standards set out in regulations which providers must meet. If a service provider fails to meet these standards, the CQC has the power to take action to protect patients. These actions include issuing warning requirements or notices, changing a provider’s registration by imposing conditions or placing a provider in special measures.

What to expect from an inspection

As part of the process, CQC inspectors will visit a service provider’s premises; such visits can often be unannounced. The CQC will either conduct a comprehensive inspection or a smaller scale focused one. A visit may be announced depending on the type of service being inspected, such as comprehensive inspections of NHS acute and specialist trusts or mental health trusts.

At the start of the inspection, the inspectors will usually meet senior staff, such as the Registered Manager, to explain the scope and purpose of the inspection and how the CQC will communicate their findings to the owner. During their assessment, the inspectors will speak to other members of staff and observe care whilst bearing these five questions in mind regarding the service:

  • Is it safe?
  • Is it effective?
  • Is it caring?
  • Is it responsive to people’s needs?
  • Is it well-led?

At the end of the visit, the inspector will hold a feedback meeting with senior staff to provide them with a summary of their findings and explain how they will make their judgement and publish it.

The ratings Following an inspection, the CQC will issue the service provider with a draft report which will include detailed commentary about the service and a rating in each domain as well as an overall rating. The ratings are either outstanding, good, requires improvement or inadequate. The service provider can respond to the draft report by way of a Factual Accuracy Comments form. This can be a very important step in the process if there are inaccuracies or omissions which may enhance a rating or the overall tenor of the report.

If a service provider receives a negative rating, the CQC can take actions such as issuing requirement notices setting out what improvements a care provider must make or issuing a caution or fine. A follow up inspection may also be scheduled.