Care Quality Commission

1. Introduction

The Care Quality Commission (CQC) is the independent regulator of health and social care in England. It monitors, inspects and regulates services to make sure they meet fundamental standards of quality and safety.

It publishes its findings, including performance ratings, in order to help people choose care. It carries out a mix of announced and unannounced inspections, which aim to get to the heart of people’s experiences.

2. Standards of Care

The CQC sets out what good and outstanding care looks like and it ensures services meet fundamental standards below which care must never fall.

2.1 Fundamental Standards

Below are the Fundamental Standards that all services aim to achieve. These standards form the basis of the contents structure of this Adult Policies, Procedures and Practice (APPP) resource.

• Person centred care: care or treatment is tailored to the individual person who uses services and meets their needs and preferences.
• Dignity and respect: all adults who use the service must be treated with dignity and respect at all times while receiving care and treatment from staff. This includes making sure they have privacy when they need and want it, everybody is treated as equals, they are given any support they need to help them remain independent and involved in their local community.
• Consent: the adult who uses the service (or anybody legally acting on their behalf) must give consent before any care or treatment is given to them.
• Safety: the adult must not be given unsafe care or treatment or be put at risk of harm that could be avoided. Staff must assess the risks to their health and safety during any care or treatment. The employer has to ensure  staff have the qualifications, competence, skills and experience to keep people who use the services safe.
• Safeguarding from abuse: adults who use the service must not suffer any form of abuse or improper treatment while receiving care. This includes:
  • neglect;
  • degrading treatment;
  • unnecessary or disproportionate restraint;
  • inappropriate limits on their freedom.
• Food and drink: adults must have enough to eat and drink to keep them in good health while they receive care and treatment.
• Premises and equipment: the places where adults receive care and treatment and the equipment used must be clean, suitable and looked after properly. The equipment used in care and treatment must also be secure and used properly.
• Complaints: adults who use the service must be able to complain about their care and treatment. The company has a system in place so they can handle and respond to a complaint. Managers must investigate it thoroughly and take action if problems are identified.
• Good governance: The company has plans to ensure they can meet these standards specified by the CQC. It has effective governance and systems to check on the quality and safety of care. These must help the service improve and reduce any risks to the health, safety and welfare of adults who use the service.
• Staffing: The company must have enough suitably qualified, competent and experienced staff to make sure they can meet these standards. Staff must be given the support, training and supervision they need to help them do their job.
• Fit and proper staff: The company must only employ people who can provide care and treatment appropriate to their role. It has robust recruitment procedures in place and carries out relevant checks, such as on applicants’ criminal records and work history.
• Duty of candour: The company must be open and transparent with adults who use the service about their care and treatment. Should something go wrong, managers must tell the service user (or their legal representative) what has happened, provide support and apologise.
• Display of ratings: The company must display the CQC rating for each service in a place where people can see it. It must also be included on the website and also make the CQC’s latest report on their service available to adults who use the service.

Where the CQC finds poor care, it will use its powers to take action.

3. Key Lines of Enquiry

As part of the CQC’s approach to inspecting adult social care services, inspectors follow Key Lines of Enquiry (KLOEs). Click on the links to access more detailed information on the CQC website.

3.1 Is the service safe?

• Safeguarding and protection from abuse: S1. How do systems, processes and practices safeguard people from abuse?
• Managing risks: S2. How are risks to people assessed and their safety monitored and managed so they are supported to stay safe and their freedom is respected?
• Suitable staff and staff cover: S3. How does the service make sure that there are sufficient numbers of suitable staff to support people to stay safe and meet their needs?
• Medicines management: S4. How does the provider ensure the proper and safe use of medicines?
• Infection control: S5. How well are people protected by the prevention and control of infection?
• Learning when things go wrong: S6. Are lessons learned and improvements made when things go wrong?

3.2 Is the service effective?

• Assessing needs and delivering evidence-based treatment: E1. Are people’s needs and choices assessed and care, treatment and support delivered in line with current legislation, standards and evidence-based guidance to achieve effective outcomes?
• Staff skills and knowledge: E2. How does the service make sure that staff have the skills, knowledge and experience to deliver effective care and support?
• Nutrition and hydration: E3. How are people supported to eat and drink enough to maintain a balanced diet?
• How staff, teams and services work together: E4. How well do staff, teams and services within and across organisations work together to deliver effective care, support and treatment?
• Supporting people to live healthier lives: E5. How are people supported to live healthier lives, have access to healthcare services and receive ongoing healthcare support?
• Accessible premises: E6. How are people’s individual needs met by the adaptation, design and decoration of premises?
• Consent to care and treatment: E7. Is consent to care and treatment always sought in line with legislation and guidance?

3.3 Is the service caring?

• Kindness, respect and compassion: C1. How does the service ensure that people are treated with kindness, respect and compassion, and that they are given emotional support when needed?
• Involving people in decisions about their care: C2. How does the service support people to express their views and be actively involved in making decisions about their care, support and treatment as far as possible?
• Privacy and dignity: C3. How are people’s privacy, dignity and independence respected and promoted?

3.4 Is the service responsive?

• Person-centred care: R1. How do people receive personalised care that is responsive to their needs?
• Concerns and complaints: R2. How are people’s concerns and complaints listened and responded to and used to improve the quality of care?
• End of life care: R3. How are people supported at the end of their life to have a comfortable, dignified and pain-free death?

3.5 Is it well-led?

• Vision and strategy: W1. Is there a clear vision and credible strategy to deliver high-quality care and support, and promote a positive culture that is person-centred, open, inclusive and empowering, which achieves good outcomes for people?
• Governance and management: W2. Does the governance framework ensure that responsibilities are clear and that quality performance, risks and regulatory requirements are understood and managed?
• Engagement and involvement: W3. How are the people who use the service, the public and staff engaged and involved?
• Learning, improvement and innovation: W4. How does the service continuously learn, improve, innovate and ensure sustainability?
• Working in partnership: W5. How does the service work in partnership with other agencies?