Exploring the new CQC assessment framework – analysing CQC guidance against practice…
We know the new assessment framework sets out CQC’s expectations for quality care using the key questions, quality statements, evidence categories, scoring and ratings. As a reminder, the key questions of safe, effective, caring, responsive and well-led, and the ratings of outstanding, good, requires improvement and inadequate remain at the heart of the new framework.
CQC’s Old Approach…
The 34 quality statements are the basis of the assessment framework and replace the KLOEs (the key lines of enquiry). CQC have also replaced their previous operating model of:
CQC’s New Approach…
CQC has shifted to a more flexible and responsive model, and this means they can update your rating at any time (following assessment), rather than only following an inspection. CQC believe the more flexible and frequent assessments of quality will ensure they, the public, commissioners, etc, have an up-to-date view of the quality and safety of your service.
Ratings may change following either/both onsite (inspection) activity and off-site assessments (where you provide CQC evidence about your compliance with specific quality statements), and we can see the new model playing out in the first published reports.
So far, we have seen a focus on five quality statements, with the assessments consisting of both on/off-site activity.
For example, under Involving people to manage risks, we can see that CQC inspectors explored:
For safe and effective staffing, the inspectors considered:
For Safeguarding, the evidence from the report included:
When the inspectors looked at Independence, choice and control, they also looked at feedback from staff and leaders:
They spoke with staff about person-centred care and asked them to tell the inspectors about what they did to ensure people had control and choice over their lives.
The inspectors spoke with people (People’s experience of health and care services) and got feedback on how people were involved in planning their care and any changes that might be required to their care plans.
The inspectors also looked at care plans (processes) to check the records, including information about how staff should support people to ensure they were reflective of the person’s needs, preferences and wishes and promoted independence, choice and control.
Finally, the inspectors explored equity in experiences and outcomes. This included processes – how the provider gathered feedback from people via monthly reviews and annual surveys. Staff conversations about how they learned about people’s experiences and feedback from people about how they were involved and how they provided feedback to the service.
Our analysis
There were few surprises in what CQC looked at; it should all feel quite familiar to you. CQC looked at 5 quality statements, and within those three evidence categories:
- People’s experience of health and care services
- Feedback from staff and leaders
- Processes
Interestingly, they didn’t gather evidence from partners (feedback from partners).
Their methods appear to reflect the CQC guidance, with in-person conversations with staff, leaders, and people and off-site collection of evidence of processes, care, and other records. The approach is much narrower, depth rather than breadth. This is more flexible and focused.
We think it will be better for providers, and you might certainly wish to check for yourselves how you currently perform against these five quality statements. Feedback about the systems in place to provide evidence to CQC (the new provider portal) appears mixed with some early teething problems.
However, we have existing systems to provide evidence to CQC, and it appears CQC worked in partnership with providers to ensure the evidence was submitted.
When might you experience CQC’s new approach?
CQC has always had a timetable for inspection activity, which will continue (you are on a list somewhere).
The CQC analyse the information they know about your service to decide the priority of your assessment activity.
For example, a RI care home service where there has been information of concern, say a whistleblower, followed by a safeguarding enquiry, alongside negative feedback provided by a family member, will be prioritised higher than a home care provider rated as good with no intelligence suggesting there may be issues.
Newly registered services have a different approach. They will still be assessed within 12 months of registration, and all 34 quality statements will likely be assessed.
We’re here to support you…
If you need help getting ready for the new assessment framework and upcoming inspection, we’re here to offer the support you need.
Our webinar, Preparing For The New Inspection Framework (written by an ex-CQC inspector), provides you with all the information you need to prepare.
We also provide coaching and mentoring for registered managers.