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Karen Ritson was a CQC inspector for 15 years and was also a regular member of the panels which award outstanding ratings for services. She played a key role in developing the KLOEs and Ratings Characteristics guidance documents. Karen now works independently with registered care services to support them to improve the quality of care they deliver and gain the best possible rating from CQC.

CQC’s 2022 Priorities

CQC is the independent regulator tasked with ensuring health and care services are safe, effective, compassionate and provide high quality care. So what is CQC’s focus for 2022 and what does this mean for adult social care providers?

CQC will look at 4 areas this year:

1. The 4 themes of the new CQC Strategy, published in Spring 2021
2. Infection prevention and control
3. Services for autistic people and those with a learning disability
4. Ongoing campaigns such as oral health and sexual health. Areas which CQC have focused on in their own publications

Let’s look at each of the main areas for the coming year.

CQC’s New Strategy

The CQC’s new Strategy has 4 themes – People & Communities, Smarter Regulation, Safety through Learning, and Accelerating Improvement. Underpinning them all is a commitment to Equality and Human Rights.

1. People and communities

   CQC recognises their regulatory approach has not always helped them listen to and act on seldom-heard voices. Their new approach however will support a wide range of people to be heard. They will proactively respond to individual comments, improve digital access, speak with people in different forums and work with partners. This is so all people receiving care are consulted, including those with protected characteristics under the Equality Act 2010. Ratings will be influenced by what people say is important to them.

   CQC’s focus will also be on effective transitions. Care providers will be held to account for their part in ensuring people’s experience is seamless when they move between services.

   People and communities: What does this mean for care providers?

   Good and Outstanding rated services already have a strong culture of consultation, where improvements in care provision can be linked directly back to what people say is important to them. This will be more important than ever. Demonstrating to CQC that the views of each and every person have been sought and acted on, and that this has led to better quality care will be an important part of preparing for future assessment. Providers should also consider their partnership working during care transitions and record what they have done to improve people’s experience.

2. Smarter Regulation
   

   CQC has found that it’s Emergency Support Framework and Transitional Regulatory Approach during the pandemic has shaped their thinking about crossing the threshold of services. They are planning to carry out site visits in response to risk and when there are concerns rather than at set intervals.

   New digital advances mean that much evidence can now be examined without site visits. CQC also plans to prioritise people’s views, consider intelligence from partners and care providers’ own self-assurance. Comprehensive on-site inspection will give way to assessments that are more focused on specific areas. Historically, ratings could not be changed unless a site visit had taken place. Ratings will now change in response to information that is received in different ways.

   Smarter Regulation: What does this mean for care providers?

   Although Good and Outstanding rated services have always had robust quality assurance systems, providers should now look carefully at the way they assure themselves of the safety and quality of care they provide. The results of your own quality assurance systems will be a huge part of what is assessed in future. Recording positive outcomes for people as a result of action taken following consultation should be a priority. CQC will be relying on this evidence more than ever to make a decision about ratings.

   Red Flag!

   A red flag to any CQC Inspector is when they uncover a problem and it's clear the Registered Manager had no idea about it. That's when they will start to dig for more information. Make sure:

   • your staff can tell you ‘bad news’
   • your quality assurance systems robust
   • identify areas for improvement and share these with the Inspector before they find them.
3. Safety through learning
   

   CQC plans to more clearly define what is meant by safety to support them to make their assessments. Services should have open and honest cultures where risks to safety are explored, positive risk embraced and improvements are based on continuous learning. CQC will assess how people receiving care will be supported to understand and contribute to the way their risks are managed so that they receive care in partnership with service providers.

   Safety through learning: What does this mean for care providers?

   It is important to review the way risk is managed and to do this longside the indivdual. People should be supported to understand the risks involved in the way they choose to live their lives. Accessible information should be provided when relevant. Staff should be offered training opportunities around safety that support their individual learning needs. The safety culture of the service should be reviewed with an emphasis on looking at when things go wrong, not only within the service but in the wider community, so that lessons can be learned. You should be open about how your approach could be improved in future.

4. Accelerating Improvement

   CQC wants to strengthen its position as a driver for improvement and to support improvement wherever it can, particularly where there is identified risk. They will challenge inequalities in access to care services and expect care providers to do their bit to reduce the risk of this in their own services. CQC will be establishing coalitions which will work to improve services and they will become involved in benchmarking and analysing data. Innovation will be encouraged and supported.

   Accelerating Improvement: What does this mean for care providers?

   CQC is committed to supporting services to decide for themselves the best way to improve. It is a great idea to take responsibility for improvement now and be proactive, researching best practice models and national guidance in relation to excellence in care provision. Innovative technologies are emerging and this is an exciting time to explore what they can offer. Technology and innovation have the power to transform the quality of data and therefore care provider’s ability to demonstrate the specifics about the quality care they provide.

Infection Prevention and Control (IPC)

The pandemic has rightly focused CQC attention on this key area. CQC is continuing to carry out IPC themed visits.

IPC: What does this mean for care providers?

Care providers need to demonstrate that they are assuring safety in the following 8 areas:

1. Visit safety. Ensure visitors to the service are protected from catching or spreading the virus. Good practice includes the provider sharing information about infections with visitors so they can make informed decisions about visiting and residents should have individual visiting care plans.
2. Support shielding and social distancing.The provider should identify those people who are clinically extremely vulnerable and support them with social distancing.
3. Safe admissions. People should be tested before the service agrees to an admission. When people are living in the service, they are assessed twice daily for Covid 19 symptoms.
4. Safe use of PPE including donning, doffing, disposal and staff training. Staff should be trained in the safe use of PPE from local specialists. There should be designated donning and doffing areas with good signage and suitable hand washing facilities.
5. Access to testing for users of the service and staff. A whole home testing approach should be implemented. Risk assessments should be carried out for staff in higher risk groups, with action plans in place to reduce risk.
6. Safe and hygienic premises that are easy to keep clean and well ventilated. Rooms should be designated for specific activities and effectively ventilated.
7. Manage outbreaks Supporting staff to prevent and safely manage any outbreaks. Staff should only work in one care setting. In larger settings they should be cohorted to work with individual groups of residents.
8. Up to date IPC policies and procedures. Good practice includes appointing an IPC lead who understands current guidelines, informs other staff and liaises with external professionals effectively.

More detailed guidance on what good looks like in each area is available here on CQC’s website.

The Needs of Autistic People and People with Learning Disabilities.

CQC has created a guide for providers of services for autistic people and people with a learning disability, Right Support, Right Care, Right Culture. Kate Terroni, Lead Inspector for adult social care has highlighted the needs of autistic people and people with learning disabilities as a key focus for CQC in 2022.

What does this mean for care providers?

• Care for autistic people and people with learning disabilities should be based on a human rights approach, where they are supported in their right to live an ordinary life
• People should be supported to enjoy their local community; for example, shops, groups and clubs
• People should be supported by sufficient staff with the right skills to provide safe, good quality care
• People should be supported to access to information about keeping safe and making a complaint
• Services should base their care on best practice guidance such as Building the right support and Building the right home

In addition, proposed services for autistic people and people with learning disabilities should be able to demonstrate:

• A clear need for the service which includes agreement or request from the local authority or health service
• That the service and the way it is designed and where it is located reflects what people need and want
• That the service has easy access to the local community and support networks such as health services and clubs
• That people’s care is organised in response to best practice guidance. For example, care should support people’s strengths and be well planned. The service should avoid restraint and seclusion with well-planned interventions that support autonomy and integration.

CQC Publications and Campaigns

Finally CQC will focus on themes highlighted by their published research in the coming year. Key examples include:

• Oral health. CQC’s available on its website. As a result of their research, Smiling Matters, CQC inspectors will check on oral health policies, staff training to support oral health, oral health care plans and arrangements for access to dental care and emergency dental treatment. CQC gives providers recommendations on how to promote oral health which include supporting staff to raise their awareness of NICE oral health guidelines and identifying people whose oral health may be vulnerable. More information is available on the CQC website.
• Sexual health.CQC’s 2020 publication Promoting Sexual Safety through empowerment. A review of sexual safety focuses on how services can keep people safe from sexual harm and how they can support individuals to express their sexuality. CQC stated that services needed to build an open culture where people felt safe having conversations about sexual safety and expressing sexuality. CQC advised providers to raise their awareness of good practice and to revisit the way risk is assessed and managed. CQC also produced a 2019 document. ‘Relationships and sexuality in adult social care services.’ This provides broad ranging advice on supporting people to express their sexuality, risk management and protection from sexual abuse and is helpful in building a person centred approach to care.

Conclusion

CQC has outlined clear themes which will be their focus for the coming year. The strong message that comes with CQC’s new strategy is to take responsibility for excellence in your own service. Develop the effectiveness of your quality assurance system to demonstrate how this has led to improvements in people’s quality of life.

CQC strategy runs alongside the other areas of focus outlined above. It’s a tall order to respond to all of this effectively. However, Good and Outstanding rated services have long been responding to all of these areas independently of CQC’s special interest. It’s what proactive services do.

The challenges of the pandemic will affect everyone in 2022. Taking time out to consider how regulation is changing will help you prepare and demonstrate your evidence of best practice - and stand a much better chance of gaining the rating you are aiming for along the way.