CQC Challenges

There are two stages of CQC challenges that you can go through after the inspection process has taken place. The first stage is the Factual Accuracy Comments (FAC) procedure, which many providers are familiar with. This allows you to go through the draft report and challenge any factual inaccuracies. Some examples may include typographical errors and incorrect information or facts that you feel were wrongly excluded by the inspector. The purpose of the FAC procedure is to ensure that the information communicated to the public through the final report is accurate and fair.

The Ratings Review Request is the second stage which many service providers aren’t familiar with. This procedure can be carried out when a provider isn’t happy with the rating it has received and wants the area ratings and/or the overall rating reviewed. You must be aware that the only ground for requesting a CQC ratings review is that the inspector didn’t follow the right process when making their rating decisions. You can’t just request a review because you don’t agree with what they have reported.

What to Expect During a CQC Rating Review

The rating review process has three stages. First, after the publication date of the final inspection report, an unsatisfied provider has 15 working days to submit a rating review request. This must be submitted via an online form on the CQC website and the word count limit for the entire submission is 500 words.

The second step involves the CQC’s independent rating review team. This team will look over the request to determine whether it qualifies for an official review. If your application is not considered to meet the CQC’s grounds, you will receive a refusal with a written letter from the CQC explaining why.

For requests that are believed to have established grounds for a review, CQC employees who weren’t involved in the original inspection will be given the responsibility to review aspects of the process that the review team believed weren’t followed properly and will determine if any changes need to be made to the ratings as a result.

The final decision will be made by the Chief Inspector (or Deputy). Potential outcomes of a CQC rating review include:

• An increase in the rating of a key question
• An increase in the overall rating of the service
• A decrease in the rating of a key question
• A decrease in the overall rating of the service
• Both increase and decrease the ratings for key questions
• Closed due to no grounds having been established
• Grounds established but no change to ratings
• Report removed in place of a new inspection
• The report was removed for the inspection team to reconsider

Challenging CQC Inspection Report

Guidance from the CQC confirms that the only grounds for requesting a rating review are that the CQC has failed to follow its own processes for deciding on a care service’s rating. It has been made clear that providers can’t ask for a ratings review on the basis that they disagree with the judgements made by CQC. However, there is often a fine line between what could be considered as questioning an inspector's judgement and failure on behalf of the inspector.

It isn’t uncommon for providers to feel like the report that has been produced by the CQC contains factual inaccuracies or the wider context of the situation hasn’t been considered. If this is the case for your care service, here are the steps to take to contest an outcome that you believe to be inaccurate.

Take Everything In

Firstly, whether you have been told in person or you’ve seen the information in the draft report, don’t let emotions take over. Whether you feel guilty, upset, anxious, worried, angry, resentful or like a failure, this is completely normal but should be controlled before making any rash decisions. Composing yourself and thinking about how you will act or respond next is key to a successful outcome.

If you are being told the news verbally, don’t be afraid to ask questions. You will need to wait for your report for the full details but asking questions will give you some insight so you can start putting a plan in place to address any concerns.

It’s also recommended that you seek support for your own health. Poor outcomes and failed inspections can take a toll on everyone within the care service, which is totally understandable. You shouldn’t feel ashamed to seek support from your colleagues, GP or other services if it’s taking a toll on your physical or mental health. Be honest with your employer as they may be able to offer support too.

Inform Your Senior Team and Nominated Individual

Before you proceed to challenge your CQC rating, you should tell your senior team or the nominated individual. When doing so, make sure you are open and transparent with the regulators' feedback. It’s often a good idea to set a meeting so you can draw up a plan of action as a team.

To prevent any further action from being taken, you need to make sure that you comply with any recommendations or requirements from the regulator.

Please note that this step isn’t always easy, in some cases, people take the news badly or fear for their jobs, but being brave and transparent is key to moving past this. At the end of the day, the news will come out regardless and you are much better off being the one to give the news as you can guide the conversation alongside being open and honest.

Plan for Media Attention

If you end up getting a poor inspection report, then you may need to prepare for attention from local or national media. Due to social media, it isn’t uncommon for news articles to spread quickly which can raise further awareness of your rating. Planning for what happens if reporters show up at your care service will help you prepare for any negativity from social media, letters or phone calls.

A great way to plan for media attention is by having media policies and procedures in place alongside a statement that confirms what you will say. Your plan should also cover how to protect members of staff and the people you support from attention or negative backlash if they end up being approached outside of the service.

Communicate the Outcome

It may have been made clear already, but communication is key when contesting an outcome. You will need to communicate the results of an inspection to your employees, the people you support, their loved ones and representatives. This won’t be easy, so make sure that you are prepared to be honest, explain where you fell short during the inspection and you can reassure everyone about the next steps you will be taking to challenge or improve your results.

Speaking to one group after another will reduce the risk of misinformation spreading. Give everyone the chance to raise their own concerns and ask any questions. Remember to be empathetic, think about how you would react if you found out a relative’s care service was underperforming. Everyone’s questions and heightened emotions are understandable, so it’s your job to reassure them and to make them feel comfortable and in the loop.

Display Your Rating

It’s a legal requirement to display the ratings of your inspection, so even if it’s lower than expected, make sure you do not fail to do this. Update information on your website and any displays within the care service or workspaces. The regulators will expect you to display your updated rating within 21 days of receiving the outcome.

Create Your Plan of Action

Drafting up a plan of action as soon as possible is recommended. As mentioned previously, you should be prepared for media attention and create plans of communication for everyone involved. Think about how to resolve issues that are highlighted in the inspection report, the timescales and any support you may need. When it comes to how you’ll address any underperforming areas, you should:

• Fully understand why the inspectors gave you that rating.
• Re-read the inspection report and understand the areas of improvement.
• Consider development or training that your staff may need.
• Review your policies and procedures to ensure that they’re up-to-date and accurate.
• Seek feedback from people including staff, service users and their loved ones.
• Create a feedback loop so you can regularly receive feedback and provide updates.

Remember, reports are usually published on the CQC website within 50 days of inspection, so make sure your plan is complete before this is in the public domain. If you identify any areas of concern, the regulator will want you to respond, so you will need to address this in your detailed action plan and list how you plan to improve through specific steps, responsibilities and timescales.

During these plans, it’s wise to anticipate any potential challenges you may face along the way. Developing contingency plans is a great way to prepare for any obstacles that may arise. A clear goal-setting strategy is a great way to help you see the bigger picture and open your eyes to challenges all while tracking your progress.

Look for External Support

You should acknowledge that there will be things that you don’t know or understand, so don’t be afraid to reach out for external support if necessary.

A care consulting service or independent consultants can be extremely helpful when it comes to creating action plans, guiding you through the outcomes and supporting you through change. They can offer information, tools and paperwork to address actions highlighted in the report. A huge benefit of having the support of a consultant is that they can share their experiences and tell you what they did to help that provider’s situation.

Monitor Your Action Plan

In most cases, the CQC will give you 6 months to make any changes. With the right planning and information, this should be plenty of time to improve the service. During this time, it’s important to regularly monitor your action plan and progress. There is a chance that you will need to make changes and adjustments to your plans based on any feedback or ideas you receive, so keep an open mind.

Contesting an Inspection Report

As you know, inspectors can make mistakes and the outcome of an inspection can be harsher than necessary. It is within your rights as a provider to contest an outcome if you believe you have grounds to do so.

Before a Published Report

When you receive a copy of your draft report which will include your ratings, you will be invited to provide feedback on its factual accuracy. The evidence can be challenged alongside the completeness on which the ratings are based. Any factual accuracy comments accepted by the regulator may result in a change to one or more of your ratings. You will only be given 10 working days to review the factual accuracy of a draft report and submit your comments.

The regulator will allow you to contest the matters raised by serving you a warning notice. The content of this notice will contain evidence regarding the breach which you can also find in the inspection report. The same goes for the factual accuracy check, contested notices that are upheld could result in the amendment of relevant ratings.

After a Published Report

A ratings review can also be requested by a provider after a report has been published. Please note that the only grounds for requesting this review are that the inspector didn’t follow the process for making ratings decisions and totalling them. A review can’t be requested solely on the basis that you don’t agree with your inspectors' judgements.

As mentioned previously, you will have 15 working days of the report being published to complete the request for a review. The cover letter that is sent with your final report will contain the instructions you need on how to submit a rating review. In the request review form, make sure you mention which rating(s) you wish to be reviewed plus all the relevant grounds.

Support for Your CQC Rating

As you can see, sometimes it isn’t easy to challenge your CQC rating but that doesn’t mean that it isn’t necessary, especially as they can have a substantial impact on health and social care services. While it can be complicated to do, we hope that this article has given you the information required to give you the confidence to challenge your rating if you feel the need to do so.

At The Access Group, we understand the importance of everything CQC and we know that things can change often, especially since the introduction of their new single assessment framework. Our CQC information hub contains all of the need-to-know information to help you stay on top of the expectations and requirements of CQC registration and compliance. You can sign up for the latest updates so you don’t have to miss a thing.

While some ratings are a mistake, other lower ratings can be avoided completely by digitising your care processes. To ensure that your care services are compliant and that your audits are as effective as possible, you should consider implementing Access Care Compliance software throughout your care service. Whether you plan to improve your rating or prepare your service for regulatory inspections, our Care Compliance software can be used to estimate your rating, track and manage your audits and perform mock inspections, so you can use your results to prepare you for the real thing.

If you would like to know more about our Care Compliance software, you can contact us to book a non-obligatory demo or to speak to one of our experts who will be able to answer any questions.