Care Quality Commission

Care Quality Commission (CQC), who are the regulators of health and care services in England, are making are making radical changes to the way they inspect and monitor services between now and 2016.

Sitra will endeavour to keep you updated with these changes focusing specifically on the regulation of care and support services. Sitra are working with CQC as part of their Trade Association which will allow us to share the views of our members whilst enabling us to provide you with the latest updates and information on the regulation changes.

Are you displaying your CQC rating? From 1st April 2015 all services are required to display their latest CQC inspection rating both prominently in their premises and on their website.  Find out more and get guidance on what, how and where to display your rating here 


May 2015

Andrea's column: Inspections...
Inspection has been a hot topic recently, specifically inspection as a way to support improvement in health and social care. I wrote about this in my blog: Inspection matters. I address three points: inspection is not the only answer, inspection is part of the answer, and the fear factor. Professionals and staff; providers; commissioners and funders; regulators; and the public, including people who use services, their families and carers all have an important part to play – and one operating in isolation from the others cannot hope to succeed. On that note, we have been developing tools that we hope you find helpful – these include guides forresidentialcommunity and hospice adult social care services on what to expect when we inspect. Read my full column here.    

Care Home Open Day – Friday 19 June
CQC staff from across England will be taking part in Care Home Open Day on Friday 19 June 2015, using the opportunity to speak to residents, relatives, staff, and visitors  about our role in making sure care homes provide care that is safe, caring and responsive to people’s needs. It is a great occasion for homes across the country to make connections with local communities and show off the terrific work, excellent management and open cultures that we expect to see organisations providing day in, day out. Find out more here.

Market Oversight video 
We have produced a short film introducing Market Oversight and what this means for providers. You can find this on our website here. Sally Warren, Deputy Chief Inspector of Adult Social Care, answers questions on what the Market Oversight scheme is, why CQC is doing this and much more.

Peter Holton appointed as new Head of Market OversightFollowing Stuart Dean’s appointment as Director of Corporate Providers and Market Oversight last month, Peter Holton has been appointed as one of two new Heads of Market Oversight. Peter brings a wealth of experience with him, previously having worked for Lloyds Bank. As Head of Market Oversight, Peter will hold a key relationship with providers who are part of the new scheme, working with them to understand their financial risk, and use the steps within the Market Oversight operating model to respond to risk and issues.

Quicker and more efficient: CQC Provider portal to open to more services this year
More CQC registered providers will soon be able to submit statutory notifications and apply to make variations to their registration via easy to use, responsive online forms. GP providers have been using the Provider Portal successfully since October 2013, and this year we will be inviting more health and social care providers, to join the Provider Portal in a phased process. We will begin to issue invitations to providers during June. You can find out more about the Provider Portal here.

Integrated care for older people: Thematic reviewAs part of our programme of thematic work, we are carrying out a review to explore how well care is organised and coordinated for older people (over 75 years old) and how this affects their experience of care. The review ultimately aims to improve older people’s experience of integrated care and support. Read more...

National dementia awareness week
The Alzheimer’s Society launched its annual dementia awareness week earlier this month. The aim is to raise awareness nationally of a condition that will affect up to a million people by 2025. Our Chief Inspector of Adult Social Care, Andrea Sutcliffe, has talked about CQC’s activity on dementia care and highlights outstanding practice in her blog. Read Andrea's blog and do something new for dementia.

Dying without dignity reportA new report that gives details of people’s poor experiences of end of life care has been published by the Parliamentary and Health Service Ombudsman. Dying without dignity  reveals numerous examples where patients and their families had negative experiences in end of life care due to factors such as poor communication, no out-of-hours support and a lack of recognition that the person was dying. Our Chief Inspector of Hospitals, Professor Sir Mike Richards, said: “The PHSO’s report Dying without dignity is timely to understand what can go wrong when people do not receive safe, effective and compassionate care at the end of their life, and in identifying learning from these examples of poor care. Read more... 


Other news

A day in the life of a care home inspection
Beth Britton, Freelance Campaigner, Consultant, Writer, Blogger – and former carer to her father who had vascular dementia – spent a day observing the CQC’s new approach to inspecting adult social care. Read more here about Beth's story of shadowing a CQC inspection that has been published on the Guardian Social Care Network. 

Procurement contract for our Experts by Experience programme
More members of the public will be taking part in our inspections of care homes from November this year. Around 475 people already take part in CQC inspections every month under our Experts by Experience programme, but this is set to rise significantly when new contracts for providing this service are procured. These contracts, worth an estimated £7 million per year, represent our largest procurement to date. 

David Prior appointed Parliamentary Under Secretary of State  
This month it was announced that our Chair, David Prior, had been appointed to the position of Parliamentary Under Secretary of State at the Department of Health. David has taken up this post with immediate effect and has therefore stepped aside from his role as Chair of CQC. The search for a permanent replacement has begun immediately. Michael Mire, a current CQC Board member, was Chair for the May Board meeting. Read more...


- 6 June 
Our Chief Inspector of Adult Social Care, Andrea Sutcliffe, will be speaking at the Alzheimer's Show 2015 in London.
24- 25 June   
Andrea will also be speaking at at the Health and Care Show in London.


On 1st April 2015 CQC introduced a number of new regulations for Adult Social Care services. This follows the launch of the new inspection regime last October which saw the introduction of expert-led inspections that follow the 5 key questions to test a service is SAFE, CARING, EFFECTIVE, WELL LED and RESPONSIVE to people’s needs.

Fundimental Standards   
All providers will also now be required to follow new regulations and meet the fundamental standards, which are the standards below which the care services provided must NEVER fall. It must be said that by meeting these standards providers are not guaranteed a particular rating during an inspection, simply that this is the minimum that people in need of case services can expect.

 The final guidance for providers is now available and includes updates on new requirements including :- 

  • Duty of Candour – where providers must be open about any mistakes that are made, apologise and provide any support required.
  • Fit & Proper Persons - Where all directors and their equivalent must be checked and monitored to ensure they are fit and proper to carry out such a role.
  • All providers are also now required to display their CQC ratings - ( within 21 days of inspection )   - both prominently on their premises and on their website.
  • CQC have a new enforcement policy which gives them the ability to be able to prosecute providers of poor care without having previously issued a warning notice, this will enable action to be taken far more quickly in cases of the most serious concern.
  • In addition a new procedure for placing providers found to be inadequate into Special Measures will ensure a timely and coordinated response to ensure the service improves quickly.
  • Finally CQC has a new responsibility for monitoring the financial sustainability of the largest and most hard to replace Care Providers. Brought about following the failure of Southern Cross in 2011 this new Market Oversight scheme will allow CQC to give advance warning to Local Authorities if they assess that a provider within the scheme is at risk, thus allowing the council to make any provision required to help ensure the least possible impact is made on people needing care. Details of the criteria for inclusion to the scheme and the role CQC will pay is now available.

At the same time all provider handbooks have been updated to reflect all the new requirements 

A new draft handbook looking at the monitoring of care within prisons and young offenders institutions is also now open for consultation. The consultation is open until 24th May.

CQC have also just published a new report ‘Celebrating Good Care’ which highlights the good and excellent service many providers give. The report highlights case studies from providers and shares the views of people responsible for care quality and what they do to drive improvement.

Older News 

Provider Guidance

Phase 1 of the full guidance for providers of all regulated services has been published. The guidance sets out how providers can meet the regulations contained within both the

  • Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
  • Care Quality Commission (Registration) Regulations 2009 (Part 4)

It also includes The Fundamental Standards – the standards below which care must never fall. Also published are the enforcement policy and decision tree. An interactive web-version of the guidance should be available shortly. 

Deprivation of Liberty Safeguards

The fifth annual report on the use of  the Mental Capacity Act Deprivation of Liberty Safeguards was published earlier this month. The report shows the massive rise in the number of applications under the act since the Supreme Court's clarification that that a person lacking mental capacity to consent is deprived of their liberty if they are both not free to leave and under continuous supervision and control. Since this clarification, there has been an eight-fold increase in the number of applications.    

Use of Monitoring Equipment

After much consultation CQC have published information to help services user, their friends and family thinking of using hidden camera’s or other equipment to monitor someone’s care. This information includes the things that should be considered before making the decision to use equipment and other ways to raise any concerns they may have about a persons care.  

Displaying Ratings

CQC are currently consulting on the requirement for providers to display their current ratings in their premises, in a location which is prominent and accessible to service users and their families. It is also proposed providers should display ratings on their websites. Further guidance will be published on this following the consultation.  

Learning from others under the new monitoring model. 

As of 11th February 979 providers of Adult Social Care had been inspected on the initial wave of the new monitoring model  of these

  • 12 ( 1%)            rated Outstanding
  • 623 (64%)        rated Good
  • 270 (27.55)      rated Requires Improvement
  • 74 (7.5%)         rated Inadequate

Of the failings noted from these visits the majority were failings in the Key Areas of Safeguarding and Leadership, far fewer failings in Care were noted. Sitra can provide training in all aspects of leadership and safeguarding so get in touch if you are worried how your service might fair in this regard and see how we can help.

Find out what it takes to be rated outstanding by reading the full reports on these providers which include 2 supported living services

The Care Certificate.

 The CQC have welcomed the introduction of the new Care Certificate and standards for the induction of new health care support workers and adult social care workers. The Care Certificate will be introduced in March 2015, replacing both the National Minimum Training Standards and the Common Induction Standards and it is expected employers will start using the Care Certificate as of April 2015.

Materials to support employers in preparing for the Certificate, including revised standards and guidance are now available for use and can be found on the Skills for Care website.

Need help in meeting these new standards? Let Sitra help you, contact us to discuss your requirements  Our training guide contains many of the courses we offer.         

Sitra are part of the CQC Adult Social Care Trade Association representing our members with the CQC at these monthly meetings. As part of this work we want to hear how the changes to CQC regulation and reporting is affecting youPlease email us with any concerns or questions you may have and we will refer them directly to the top contacts within CQC. 

Adult Social Care – Inspections and Ratings

From October 2014 CQC are changed the way they inspect Adult Social Care services. This new methodology will be known as Fresh Start and will include a new system of rating services by assessing how well they perform against the 'Mum Test'.

CQC will rate services by following the ‘Key Lines of Enquiry’ (KLOEs) during inspections and assessing their findings against the ‘Characteristics of Ratings’. There are different KLOEs and Characteristics for different kinds of services; you can read the draft versions on the CQC website and final versions of the documents will be published together with a provider handbook in early October. 

The KLOE documents and ratings are all based around the 5 key questions which form the 'Mum Test' focus of the new regulation of all services by CQC

These are:-

  • Are they safe?
  • Are they effective?
  • Are they caring?
  • Are they responsive to people's needs?
  • Are they well-led?

Prior to an inspection services will be asked to complete a Provider Information Return (PIR). This form should be an effective way for provides to compile and submit the key information that inspectors need before a visit. 


All adult social care services will be awarded ratings of:

  • Outstanding
  • Good,
  • Requires Improvement,
  • Or Inadequate

Based on the experience of the first wave of inspections it is anticipated that services will be rated across all four levels with the vast majority of services falling within the middle two of 'Good' and 'Requires Improvement'.

Any service which has a concern over the rating they have been awarded will be able to raise this using the existing factual accuracy process. As ratings are based on evidence this process allows providers to raise their concerns over the evidence in our inspection reports. In addition, providers will be able to ask for a review of their ratings where they feel the published process for awarding a rating has not been followed properly. This can only be requested once the inspection report has been published, any subsequent changes in ratings will be included in re-published, amended reports.

Information about how to use the factual accuracy process is included in the documents supporting the draft inspection reports, while the details of how to request a review of ratings process will be included the letters and emails that accompany final inspection reports.

Provider handbooks set out how CQC community and residential services in adult social care. The handbooks are designed to give providers the full details of the new regulatory model and which have been designed together with people who use services, care providers, commissioners and national partners. The handbooks match the information and guidane used by CQC inspectors and can be downloaded here - 

Read CQC’s latest Adult Social Care provider newsletter or more general newsletter.

Read the CQC's - STATE OF CARE 2013/14 - The Annual Report into care and support in England

Are you concerned about the new inspections and ratings or the wider regulation of services?

Sitra can help by:-

  • Providing bespoke support to help your organisation understand the current changes and the implications for you.
  • Run workshops for organisations thinking of moving into care provision or extending their support offer
  • Provide training for staff around CQQ standards
  • Offer training courses on a wide variety of care and support topics including:- end of life care, diabetes. dementia, mental health - see our training guide for all the courses we offer. 
To find out more about any of our services contact us

Duty of Candour

An overview of this new regulation