Your CQC inspection checklist

Speaking to everyone involved with a care service is one way the CQC inspector will gather evidence and assess your service against the CQC standards.

Ensuring your care staff are prepared will help them understand what the CQC inspector is looking for and prevent them giving an unduly negative view of your service.

It should also help them feel more confident and less nervous if being questioned by the CQC inspector. We can all probably recall a time when we felt nervous or under pressure and forgot important details, or did not perform as well as we could have done if we were calmer.

Some care providers put together a pack (for example a PDF or print out) for staff, giving them the key information they should have in mind before and during an inspection. 

You also want your staff to be familiar with those areas where you feel you are strongest, so they are ready to highlight them during an inspection.

Most of your care team don’t need to understand all the complex ins and outs of regulations, but they should have a good grasp of:

• The CQC 5 Standards
• The CQC Fundamental Standards
• The methods CQC uses to gather evidence
• Your social care policies and procedures and where they can find them, especially in areas of safety and quality, for example: whistleblowing, confidentiality, complaints, safeguarding adults, medicines administration.
• Key personnel in your organization such as safeguarding leads
• Duty of candour

Below are some of the most common questions CQC inspectors will ask if they interview one of your care workers.

It would help to do practice runs with staff, of these and other questions throughout the year. This can help you identify and address shortcomings (for example staff not being aware of a specific safeguarding policy). It should also help make staff feel more confident and familiar with the process if they are interviewed by an inspector:

• How do you see your role here?
• How long have you been working here?
• How did you find and apply for the position?
• What do you like/dislike about your job?
• Do you have any current concerns about the care service?
• How do you feel management treats you and your colleagues?
• Do you feel well supported in your role
• Do you understand your job description, your responsibilities and do you have a staff handbook?
• Did you undergo a CRB/DBS check when applying for the role?
• What training have you received or courses completed?
• What are the ‘out of hours’ arrangements?
• Who this care service’s safeguarding lead/s?
• Where are the anaphylactic kits and are they checked regularly?
• How are incidents and accidents recorded?
• How do you treat people with dignity and respect?
• What is person centred care and how do you provide it?
• How do you maintain confidentiality for service users and why is this important?
• Are you aware of the complaints procedure – can you describe it?
• When was your last staff appraisal? Was an action plan created and how did you work through the objectives in it?
• Do you have a whistleblowing policy? Can you describe it?
• Do you feel comfortable to ‘whistle blow’ if needed?

The CQC love to see providers innovating, for example by using new technology or partnering with local organisations. But what really matters to the CQC is if and how your innovative approaches benefit the people you provide care to.

In order to get the recognition you deserve during an inspection, you need to evidence how innovation has led to specific outcomes.

For example, has partnering your care home with that local free transport charity and the outings your residents have been on as a result led to improved wellbeing? And if so is this documented, can you evidence it?

Or is the new medicines management software you’re using reducing medicines errors for your residents. Can you evidence this easily within a report in that software?

To be best placed for the inspection you should have well documented records of events, how you responded to each event (actions) and what the outcome was.

Ideally this should be linked together or easily accessible so the inspector can see that you are taking the steps to understand why a good/bad event occurred and applying those learnings to improve the care service.

Events could include:

• Positive feedback from a service user – is there an example of good practice that could be communicated across the service so it is replicated? Was it? What were the results if any?
• Complaints – what actions did you take to address this complaint, what was the outcome? Were there learnings you could apply elsewhere to improve the service? Were those learnings applied? Did this result in an improvement?
• Incidents – how was the incident investigated, what actions were put in place to prevent it recurring? Were these replicated across the service where relevant? Were there any results/outcomes you could share?

Whether on an electronic care planning system, or any other format, you need to ensure your documentation (such as care plans and risk assessments) are well organized and easy to navigate through.

Missing parts of a person’s care record are a definite no-no. Likewise, fundamental things like ensuring care plans are reviewed and updated frequently enough, that risk assessments have sufficient detail, that information from risk assessments and care plans match up, that care plans demonstrate a person centred care approach.

These are all things you should already be doing to ensure high standards of care and safety, but its important that your documentation reflects this to you, your staff and any CQC inspector.

In short don’t let slippages in admin or organisation let you down and give a worse impression of your care service, and the care it is delivering than is the reality.

More often overlooked than care documentation, you need to ensure your personnel files are in order. Make sure each staff member’s record has a copy of their DBS certification, right to work and so on. Ensure staff have signed somewhere to Their file should also include records of training and qualifications they’ve undertaken

As with care documentation you want to ensure all this information is cohesive, sufficiently detailed, up to date and well organized.

During the inspection if you or a member of staff is unclear about what the CQC inspector is asking for or about, don’t try to bluff it. Sometimes people use different terminology or do things in slightly different ways.

The CQC inspector is not assessing whether or not every care provider does everything in exactly the same way. They’re not expecting perfection and everyone to know everything at all times either. They want to see if you are delivering care safely, to a high quality and how you do this.

Likewise at the end of the inspection don’t be afraid to ask if the CQC inspector couldn’t find some information they were looking for, or if they wanted to speak to someone else but they were not available.

This could tie up a loose end that might have dragged your rating down, or ensure your best bits are highlighted. It also shows you are open and not trying to hide anything.

I’ve heard anecdotally of care inspectors directly asking care managers at the start of their inspection; “So why do you think you should be rated Outstanding?”

If you can’t answer this question when asked, it could signal that either you don’t understand what Outstanding care means, or you do understand and don’t feel your service is Outstanding, or Good.

Now you don’t need to write the inspection report for the inspector, or give them an hour long slide show on how great your service is.

But you should have your own understanding of some key reasons why you feel your service provides Good or Outstanding care that you can draw upon. This could be your high standards of care and safety, with examples. Satisfaction surveys from the people you support, external recognition and so on.

It could also incorporate your values and culture, or your approach to auditing, learning and improving.

Doing the thinking and the investigation to understand what your care service’s strongest areas are means you can highlight them more easily and reliably during an inspection. The process can also help identify areas you want to improve or strong points you want to ensure are replicated across your service/s.

Mock CQC inspections are a great way to assess aspects of your service using the CQC’s own inspection methods and ratings criteria, to get a sense of the rating you might get now and the areas you need to improve in order to get a better rating.

Better you spot these and address them than an inspector and it affect your rating negatively.

Mock CQC inspections can also help identify strong performance that you can highlight during an inspection.

Depending on how close you are to a CQC inspection you may not be able to do a mock inspection in time.

CQC Mock inspection options

You can construct your own mock inspection using the information CQC has put online as to how it inspects and rates care services. Although you may be less confident with this approach, it is free, but will take quite a lot of time for you to put together.

Another option is to pay for each mock inspection using a consultancy which specialises in CQC compliance. These people are usually experts so you can be more confident than constructing the mock inspection yourself.

However they are expensive and you will need to book them in and fit them around actually running your care service. If regulations change you may need more mock inspections which means more spending and more disruption.

Mock inspections can also be conducted using CQC compliance software. This approach has a number of advantages, you can conduct mock inspections whenever and wherever you like and the system automatically updates with the latest regulation changes.

It allows you to approach mock inspections in a systematic way, building action plans to address issues you’ve uncovered and track how you are improving. You can even roll these out as evidence during an inspection to impress the inspector.

The key focus of CQC inspections on the experiences people have when they receive care and the impact the care has on their health and wellbeing.

Aside from following the Key Lines of Enquiry, the CQC also look out for evidence of actively listening to feedback and frequently engaging with their clients, family members, funders, and other stakeholders to improve their service. The CQC will reward those who proactively collect and act on feedback from those stakeholders as part of their philosophy.

Technology is also a new element to the CQC’s latest regulation framework, so care providers who can demonstrate effective use of technology for care monitoring are more likely to receive an outstanding rating.

Care providers who have good systems for delivering and monitoring care in place have generally found that it speeds up the inspection process.

Being able to provide data that the inspector requests is quicker with the use of technology, meaning an inspector can have access to what they need quicker turning a task that would normally take 2 days into a few hours. 

The frequency of a CQC inspection depends on the previous rating. For example, a care provider who has achieved good or outstanding will be next inspected within 5 years. Providers who achieved ‘requires improvement’ will be inspected again within 12 months. Finally, providers who achieved ‘inadequate’ will be inspected again within 6 months.

New care providers will receive their first inspection within 12 months of them registering.

Care providers can also be inspected if an incident is raised, also known as whistle blowing. This is called a focused inspection; they are on a smaller scale compared to a comprehensive inspection. Focused inspections are carried out for whistle-blowers or when a concern is raised through a comprehensive inspection or monitoring work.

These inspections are also completed if there is a change in the care provider’s circumstances, for example if it has been taken over, there has been an acquisition or services have merged.